Analyzing Internal Bleeding: The Truth Behind Americas Terrifying Epidemic of Medical Mistakes

Abstract

This paper will analyze 4 chapters from the book Internal Bleeding. Chapter 12 Hubris and Teamwork, chapter 14 Spilling the beans, chapter 15 Whether reports, and chapter 20 A Culture of Safety. Each chapter will be explored and a weakness and a strength of the chapters will be explained. My personal opinion about each chapter will be told as well.

Chapter 12: Hubris and Teamwork

"Even when fatigued, I preform effectively during critical time." (p. 223) This is a quote that me ponder how doctors and surgeons are practically superhuman. A doctor can be over confident which translates to a medical mistake. A life is in the hands of a doctor and be terminated easily with just one small error. "Tired or confused doctors think nothing of pressing ahead and refuse even to acknowledge that this intransigence just might cause their patients harm" (p. 223) This captures the title perfectly. Hubris and teamwork. An anecdote that caught my attention was the anesthesiologist and surgeon brawl that took place in the operating room."They lunged at each other and grappled on the floor feet of their stunned associates. After a moment, they separated and went back to their respective corners. As if the whole thing never happened."(p. 222) When something so scandalous happens, it is hard to believe that well educated adults that resort to such savagery act of fighting. With superiority come hubris. Some doctors develop a confidence while practicing and others develop arrogance. Because some doctors are arrogant, they believe that they are above all hospital staff and they do not like to be questioned on the things they do or the orders they give. An anecdote was given at the beginning of the chapter. A code blue was called when "Jane Hyatt, had just found her patient gray-blue, not breathing, and without a pulse."(p.209) The code team is doing everything possible to save the mans life. There is confusion of the mans identity just trying to name him and what his case is. In the midst of the attempt to save the mans life information on his chart stated a DNR (do not resuscitate). A "No code". The code team had to bite their tongue and respect the wishes of the patient. Minutes after a nurse is reviewing the patients chart and realizes that the wrong patients chart was referred to when the code was initially called. A code blue was called when the nurse discovered the pivotal information. It was too late the damage was done and with crucial time lapsed, the mans life was not salvageable. The mix up of chart has been constantly happening in hospitals and contributes to the fatality of medical errors. Communication is key when a team must preform. In the medical profession communication between nurse and doctor are on unstable grounds. Doctors superiority prevent nurses to speak up because they do not want to be shut down or embarrassed. Nurses are often discredited by doctors. The simile given, (p.221) "The surgeon is like a field commander," is a great comparison to the position that a surgeon should have in surgery when there is a life and death decision to be made. Personally i like the mentions of medical dramas. For me, that reference was a strength in the chapter because it caught my attention and made the book relatable. I am a big fan of medical dramas, like Grey's Anatomy, NIp/Tuck and House. There are so many scenarios that a similar between the book and the show. Some weaknesses in this chapter is that it doesn't explain that all doctors are the same. There are a few that are open minded and up for suggestions. Personally, I liked this chapter because it added a little spice to the book. It was fun to read the anecdotes in this chapter they were interesting. Reading about what goes on behind the operating room door makes me have a piece of mind. Knowing that now a Crew Resource Management (CRM) is now being practice in medicine it makes me feel insured. "CRM recognizes that while machines can break, they don't make mistakes; people do" (p. 227) with this program it teaches how to trap errors and to help with the safety problems. I think with the advances in technology there medical errors are going to decrease significantly.

Chapter 14: Spilling the Beans

In this chapter a tragic anecdote was told. Jesica Santillian was a young girl who was in need of a heart transplant. Dr. Jaggers is a great surgeon that had jesica under his care. He had her on the donor list which would be a long wait because she was not prority. "For Jaggers, Jesica's was an extraordinarily high profile case, and both the surgeon and his staff undoubtedly felt the crushing pressure to find a suitable donor." The odd of Jesica receiving a heart soon was out of the question. however by some miracle, Dr. Jaggers receive a call from UNOS asking if another patient of his could use a heart, but it was not a match. Because the donor heart had a limited time to be transplanted it had to go to someone local that could accept it. Jaggers suggested that Jesica could use the heart, and just like that they were going to get prepped and ready for the transplant. After being in surgery it is found out that the donors blood is not compatible with Jesica's blood type. This massive error was fatal. How could something so simple as matching blood types be overlooked? Jesica was not on the donors list yet so all of her information was not uploaded. Dr. Jaggers overlooked a simple blood type that would cost Jesica her life. The media following Jesicas case makes the mistake much more difficult to admit to. "Although full disclosure is unquestionably the right thing to do ethically, what about it financial implications? Does a confession make a lawsuit more likely, as some risk managers fear or,less likely, as psychologist Vincent suggests?"(p.263) are all question that are running through their minds. Being under the public