In 2010, Dr. Jonathan R. Welch’s mother died after a medical error that he watched unfold and felt powerless to do anything about. Now an emergency room doctor at Brigham and Women’s Hospital, Welch recently wrote an essay in the journal Health Affairs about the care she received and medical errors more generally.
Q. You chose not to sue because you felt it would drag out your family’s misery, but wrote this essay instead. What were you hoping it would accomplish?
A. I was looking for a way to make sure this didn’t happen to somebody else. Writing the piece and the downstream effects has been a real positive way to have a legacy for my mom.
Q. Did your mother’s problem — a systemic infection during treatment for breast cancer — require specialized care?
A. It was a reasonably clear-cut case. They didn’t follow national standards and it led to a potentially preventable death.
Q. Do you think smaller hospitals, like the one in Wisconsin that treated your mother, make more errors than big, teaching hospitals?
A. I don’t know if size necessarily has a lot to do with it. What I think really matters at the end of the day is culture. I think you need [hospital] leadership to say: “This is important to us. We’re not going to have people die unnecessarily on our watch, and we’re going to listen to patients and families.”
Q. You challenged the care your mother was getting, and then you had her transferred to the intensive care unit, but she still didn’t get the care required.
A. From a physician’s perspective, it was heartbreaking to know that there were things that could have been done potentially to save my mom and weren’t. It almost felt like the reality had flipped. What would happen if I challenged my mother’s oncologist for a second time and said this isn’t working? If she got out of the hospital successfully, how would she continue chemotherapy? What would her relationship [with her doctor] be like?
Q. And that helplessness you felt convinced you of the importance of involving patients and families in care?
A. I think this was really the wake-up call for me. I thought I had the best possible way of affecting change. I was a physician. I knew their language. And it was a reasonably clear-cut case. They didn’t follow national standards and it led to a potentially preventable death.
Q. What do you think hospitals can do to improve patient care?
A. There are initiatives now where patients can go onto the electronic medical record portal of the hospital and get access to their medical records. In preliminary studies of clinics that have been doing that, the patients report that they feel more in control of their own care — they’ve even reported that they’re more faithful to taking their medications.
Another is that we’re transforming the transfer of information between doctors and nurses from outside of the patient’s room to the bedside. That offers really interesting opportunities for patients to learn what the plan of the day is, what the outcomes are that we’re looking for, what kind of change we’re trying to affect with the patient. [Transfers are] a dangerous time in patient-care. Having patients or family members there is a really valuable way to ensure that information remains accurate.
Q. You mentioned that some hospitals have “rapid response teams.” What are these and could they help in cases like your mother’s?
A. If patients are getting dangerously worse, health care workers can essentially pull an emergency lever and get physicians, nurses, administrators to the bedside. . . . The family member . . . can pull that lever [too] and say, “Dad’s getting worse. Something’s not right here.”
Q. How do you think the incident with your mother changed you as a doctor?
A. I always thought patients and family members could tell us valuable information about what I would categorize as service-level elements of what we do. I wanted to hear from our patients and family members when our waiting room times were too long. [But] I don’t think I recognized before this experience that patient and family input could actually transform health care outcomes and health care costs in really meaningful ways.
Q. Do you feel guilty that you weren’t able to save your mother?
A. I clearly wish that on that night I had spoken up for the fifth or sixth time. That was hard to deal with. I also recognize that any hospital that requires a family member to act like a doctor in order to get their family member good care is probably in trouble. That’s not a good way to deliver safe and effective care.
Q. Your mother’s doctor and hospital never apologized for the care she received. Do you think they should have?
A. I think health care workers are doing a better job of learning about the importance of apology when medical errors or sub-optimal care occurs. It clearly is a challenging situation for individuals to admit a mistake, but I think it’s part of the healing process for people who have been victims of errors.