All of Us—Doctor and Patients—Need to Face up to Healthcare Hazards

By Deepak Chopra MD, Nancy S. Cetel, MD, Danielle Weiss, MD, Joseph B. Weiss, MD

Medical mistakes are a touchy subject in the medical community. Both sides of the healthcare system fear them—patients because of their general anxiety about going to the doctor, physicians because of the looming threat of malpractice. The situation needs to be faced squarely, with candor and above all, with reliable statistics. These have varied widely over the years. While the numbers of fatalities reported annually in US hospitals has had estimates from 44,000 to 440,000, even the lower estimate is a public health catastrophe.

We say this against the background of the vulnerable position even the best cared for patient faces. Entering the hospital represents a loss of freedom, exposure to anxiety-producing procedures, a sterile environment, and being handled, physically and emotionally, by strangers. Adding medical mistakes to the list must become unacceptable.

At present, however, preventable mistakes continue to persist and are often more grave. Several publications over the past two dozen years, including our own, have highlighted the alarming frequency and consequences of adverse events during medical treatment. Among the most credibly researched and analyzed findings are the following:

* The US Department of Health & Human Services, Office of the Inspector General, reported that a review of in-patient records from 2008 confirmed 180,000 fatalities occurred in the Medicare population alone, because of medical errors.

* A 2013 evidence-based estimate, using a weighted average of 4 databases, suggested that the current range of annual deaths in US hospitals from adverse events was between 210,000 to over 400,000.

* Most recently, in 2015, journal authors from Johns Hopkins estimates the number as over 250,000 deaths per year, making hospital errors the third leading cause of US hospital deaths after heart disease and cancer.

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Regarding the last citation, Dr. Martin Makary, Professor of Surgery and Health Policy at the Johns Hopkins School of Medicine, comments that medical care gone wrong is commonly due to “a communications breakdown, poorly coordinated care, or a misdiagnosis,” but these are rarely mentioned when a doctor fills out “primary cause of death” on a death report.

 

As a result, Makary notes, “these are issues that have lived in locker rooms, doctors’ lounges, and nurses’ stations…in the form of stories and not epidemiological errors.” A recent review of 4,000 medical journal articles showed that even the most accurate medical record review protocol identified adverse events in 2.9% to 18.0% of records, with preventable errors identified in 1% to 8.6% of records. Although alarming in its own right, this number is a significant underestimation of the true frequency of errors. In a telling report that interviewed nearly 1,000 patients in Massachusetts 6 to 12 months after discharge, patients recalled three times the number of adverse events reported in the medical record.

 

The many reasons why errors would be underreported is all too readily apparent. Avoidance of identification, liability, blame, guilt, financial penalty, malpractice action, job security, disciplinary action, hearings, reviews, etc. are just some of the powerful motivations to avoid reporting an error. Surveys of physicians confirm the obvious, that under-reporting is widespread. Yet without accurate statistics the full extent of the endemic problem, as well as the ability to monitor efforts to reduce errors, cannot be accurately assessed. Human error is inevitable, but every effort must be made to minimize the risk and consequences.

 

 

Deepak Chopra MD, FACP, Clinical Professor of Medicine, University of California, San Diego, Chairman and Founder, The Chopra Foundation, Co-Founder, The Chopra Center for Wellbeing

 

 

Nancy S. Cetel, MD, President and Founder, Speaking of Health and specialist in women’s health and reproductive endocrinology.

 

 

Danielle Weiss, MD, Clinical Assistant Professor of Medicine, University of California, San Diego, Medical Director & Founder, Center for Hormonal Health & Well-Being

 

 

Joseph B. Weiss, MD, FACP, Clinical Professor of Medicine, University of California San Diego.

 

 

References:

 

Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370–6.

 

Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington DC: National Academy Press, 2000.

 

Department of Health and Human Services. Adverse events in hospitals: national incidence among Medicare beneficiaries. 2010. http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf.

 

A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care James, John T. PhD Journal of Patient Safety: September 2013 – Volume 9 – Issue 3 – p 122–128

doi: 10.1097/PTS.0b013e3182948a69

 

Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ 2016;353:i2139. doi:10.1136/bmj.i2139

 

Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review. Mirelle Hanskamp-Sebregts, Marieke Zegers, Charles Vincent, Petra J van Gurp, Henrica C W de Vet, Hub Wollersheim Published 22 August, 2016 http://bmjopen.bmj.com/content/6/8/e011078.full

 

Weismann JS, Schneider EC, Weingart SN, et al. Comparing patient-reported hospital adverse events with medical records reviews: Do patients know something that hospitals do not? Ann Intern Med. 2008; 149: 100–108.

 

Overview of medical errors and adverse events. Maité Garrouste-Orgeas François Philippart, Cédric Bruel, Adeline Max, Nicolas Lau and B Misset Annals of Intensive Care 20122:2

DOI: 10.1186/2110-5820-2-2 Published 16 February 2012

 

Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P: Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009, 338: b814. 10.1136/bmj.b814

 

Ridley SA, Booth SA, Thompson CM: Prescription errors in UK critical care units. Anaesthesia 2004, 59: 1193–1200. 10.1111/j.1365-2044.2004.03969.x

 

Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, et al.: Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II on behalf of the Outcomerea study group. Am J Respir Crit Care Med 2010, 181: 134–142. 10.1164/rccm.200812-1820OC

 

Garrouste-Orgeas M, Soufir L, Tabah A, Schwebel C, Vesin A, Adrie C, Thuong M, Timsit JF: A multifaceted program for improving quality of care in ICUs (IATROREF STUDY) on behalf of the Outcomerea study group. Critical Care Med, in press.

 

Overview of medical errors and adverse events. Maité Garrouste-Orgeas, François Philippart, Cédric Bruel, Adeline Max, Nicolas Lau and B Misset Annals of Intensive Care20122:2

 

DOI: 10.1186/2110-5820-2-2 Published 16 February 2012

 

Kennerly DA, Kudyakov R, da Graca B, et al. Characterization of adverse events detected in a large health care delivery system using an enhanced Global Trigger Tool over a five-year interval. Health Serv Res 2014;49:1407–25. doi:10.1111/1475-6773.12163 Google Scholar

 

Rutberg H, Borgstedt Risberg M, Sjodahl R, et al. Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method. BMJ Open 2014;4:e004879. doi:10.1136/bmjopen-2014-004879

 

Christiaans-Dingelhoff I, Smits M, Zwaan L, et al. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports? BMC Health Serv Res 2011;11:49. doi:10.1186/1472-6963-11-49 [CrossRef][Medline]Google Scholar

 

Classen DC, Resar R, Griffin F, et al. ‘Global Trigger Tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood) 2011;30:581–9. doi:10.1377/hlthaff.2011.0190

 

Sari AB, Sheldon TA, Cracknell A, et al. Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Qual Saf

 

J Health Care Finance. 2012 Fall;39(1):39-50. The economics of health care quality and medical errors. Andel C1, Davidow SL, Hollander M, Moreno DA. https://www.ncbi.nlm.nih.gov/pubmed/23155743

Everyday Reality is a Human Construct

By Deepak Chopra, MD

It is often overlooked that the role of spirituality was once the same as the role science plays today: to explain how Nature works. As science views reality, objective facts and rational thinking outstrip the traditional spiritual worldview, which explained Nature through higher powers known as the gods or God. But recently the playing field has become much more level than anyone ever anticipated.

Explaining reality through objective means has seriously eroded, chiefly because as science drew closer to the source where space, time, matter, and energy emerge, Nature as we know it vanished. At the level of the quantum vacuum, the zero point of empirical knowledge, something inconceivable is at work. Only advanced mathematics remains as a useful tool when time and space no longer exist, and even then, our mathematical models are suspect, because there is no longer any proof that they actually match reality.

To visualize this situation, imagine that you are a traveler who has followed your tour guide to a borderline. He turns and says, “Up to now we have crossed the land where causes lead to effects, where clocks measure time and space has three dimensions, where physical objects are reliably solid. No doubt you’ve already noticed that your five senses no longer operate, and we had better be careful taking another step, because your mind won’t be capable of reasoning out anything across this borderline. Shall we cross?”

You can imagine that you would hesitate, because across the borderline is simply “beyond,” a realm where reality originates even though nothing we consider real exists. It’s remarkable that thousands of years ago, looking inward through self-awareness, ancient thinkers reached the same borderline, and what they imagined “beyond” wasn’t in fact gods or God, because religion arrived much later to offer a simpler story about “beyond.” The non-simple story was about pure

consciousness. Where science views “beyond” as a dark mystery, the ancient thinkers of India saw the starting-point of reality as a state of awareness that is actually reachable.

In both cases the familiar world of space, time, matter, and energy disappears across the borderline, but for modern science, which takes objective facts as the most reliable guide to reality, there’s a breakdown, because beyond the zero point, the absence of data means there are no more objective facts. In the worldview we dub as spiritual, however, reality doesn’t break down. The “beyond” is continuous with our world as the source of experience.

It turns out, when it comes to explaining reality, that where you start has everything to do with where you end. If you start with conscious experience as your measure of reality, the end is pure consciousness. If you start with physical objects “out there,” you end up with emptiness, a void. A scientific skeptic might protest that the “beyond” can’t be different for two people just because they began with different assumptions. Two travelers visiting the Pyramids are going to see the same thing, no matter what they expect when they set foot on the plane.

But the extraordinary thing is that the “beyond” is an exception. It can be the source of awareness or an empty void, entirely depending on how the human mind constructs it. If the world “out there” is real, once it vanishes into the quantum vacuum, the “beyond” is an empty void or at best a theoretical mathematical space. But if conscious experience is real, then consciousness was constructing reality all along. Having arrived at the borderline, we can look back over our shoulder and say, “Oh, I get it now. Everything I ever thought was real is constructed from consciousness. Consciousness isn’t an add-on. It’s the only thing that was real in the first place.”

This simple realization is what the East calls enlightenment or waking up. One sees that physical reality is a human construct and always has been. When we are in bed dreaming at night, a dreamscape can feel entirely real, but on the moment of waking up, we realize its illusory nature.

To a rationalist who bases his worldview on physical objects “out there,” it sounds bizarre to say that one can also wake up and see the familiar world as a dreamscape. But that’s the great challenge of spirituality, which we should more accurately called consciousness-based reality.

The ancient thinkers explained with detailed specificity how consciousness constructs the entire range of reality from the grossest to the subtlest phenomena. For simplicity’s sake, one can reduce the explanation to twelve salient points, as follows:

1. Everyday reality appears to be a given, but on investigation, it reveals itself as a human construct.

2. The building blocks of reality are not tiny physical objects (atoms, subatomic particles) but exist in our awareness, where everything begins and ends as an excitation (activity) in consciousness.

3. We know reality as the experience of observer and observed occurring in the now. The fundamental experience of both observer and observed is in the form of mental sensations, images, feelings, and thoughts (SIFT).

4. Sensations, images, feelings, thoughts are entangled modifications of awareness, the result of social and cultural conditioning and accepted systems of education. Our awareness gets deeply involved in many systems (education, politics, gender, religion, etc.).

5. Systems are arbitrarily made and changed. Therefore, no construct has a privileged position over another. Truth is always relative inside any system.

6. These constructs, however, are intensely real for the individual awareness embedded in it. We allow ourselves to be programmed by such systems and would feel naked and

vulnerable without them. In the world’s wisdom traditions, this is known as the state of bondage.

7. Excitations of awareness are not as basic as pure, timeless, dimensionless awareness. They modulate pure awareness like a switch that brings the familiar world into existence/experience.

8. Excitations or vibrations take place in the domain of time; in fact, they create the sensation of time itself. Pure awareness is timeless.

9. We are entangled in a vibrational reality that feels real on its own terms but is basically a mental construct, like a dream. To realize this is known as “waking up.” To someone who is awake, everything in the phenomenal world exists on the same playing field. As constructs, the same status is shared by birth, death, body, mind, brain, universe, stars, galaxies, the big bang, and God or the gods.

10. Freedom lies in the experience of knowing yourself beyond all constructs. You are pure awareness before the subject/object split came about.

11. All human suffering is the result of attachment to a construct, including fear of the construct we call death. Death is only real within the limits of the construct we manufactured. It doesn’t occur to the awareness that stands apart and sees all experiences rising and falling in the timeless moment of now.

12. The ultimate goal of all experience is the same: finding the “real” reality in one’s own being.

These points are just as logical and consistent as modern science, and one can argue that they are much more sound as philosophy, given that science hasn’t come close to explaining how bits of matter created conscious awareness while these points assume something everyone knows to be true: we are conscious beings. As unconventional as they may seem, these points offer a better way to find out what’s real. And we don’t have to debate whether ancient thinkers can rival modern advanced science. Consciousness-based reality is just as testable today as it ever way. Each person’s challenge is to accept the invitation to journey inward or not, because ultimately, going beyond depends on individual experience and nothing else.

Deepak Chopra MD, FACP, founder of The Chopra Foundation and co-founder of The Chopra Center for Wellbeing, is a world-renowned pioneer in integrative medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism. He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. The World Post and The Huffington Post global internet survey ranked Chopra #17 influential thinker in the world and #1 in Medicine. Chopra is the author of more than 80 books translated into over 43 languages, including numerous New York Times bestsellers. His latest books are Super Genes co-authored with Rudolph Tanzi, PhD and Quantum Healing (Revised and Updated): Exploring the Frontiers of Mind/Body Medicine. www.deepakchopra.com

Six-Day Clinical Trial Finds Integrative Medicine Program Alters Blood Serum

Six-Day Clinical Trial Finds Integrative Medicine Program Alters Blood Serum

Meditation, yoga and vegetarian diet linked to decline in plasma metabolites associated with inflammation and cardiovascular disease risk

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In a novel controlled clinical trial, participants in a six-day Ayurvedic-based well-being program that featured a vegetarian diet, meditation, yoga and massages experienced measurable decreases in a set of blood-based metabolites associated with inflammation, cardiovascular disease risk and cholesterol regulation.

 

View the Study: Integrative Medicine Program Alters Blood Serum

 

The findings, published in the September 9 issue of Scientific Reports, represent a rare attempt to use metabolic biomarkers to assess the reported health benefits of integrative medicine and holistic practices. Senior author of the study, which included researchers from multiple institutions, was Deepak Chopra, MD, clinical professor in the Department of Family Medicine and Public Health at University of California San Diego School of Medicine and a noted proponent of integrative medicine.

 

“It appears that a one-week Panchakarma-based program can significantly alter the metabolic profile of the person undergoing it,” said Chopra, whose foundation provided and managed funding for the study. “As part of our strategy to create a framework for whole systems biology research, our next step will be to correlate these changes with both gene expression and psychological health.”

 

Study co-author Paul J. Mills, PhD, professor of family medicine and public health and director of the Center of Excellence for Research and Training in Integrative Health, both at UC San Diego, noted that alternative and integrative medicine practices, such as meditation and Ayurveda, are extremely popular, but their effects on the human microbiome, genome and physiology are not fully understood. “Our program of research is dedicated to addressing these gaps in the literature.”

 

We looked at the effects of a Panchakarma-based Ayurvedic intervention on plasma metabolites in a controlled clinical trial,” said lead author Christine Tara Peterson, PhD, a postdoctoral fellow at UC San Diego. Panchakarma refers to a detoxification and rejuvenation protocol involving massage, herbal therapy and other procedures to help strengthen and rejuvenate the body.”

 

The study involved 119 healthy male and female participants between 30 and 80 years of age who stayed at the Chopra Center for Wellbeing in Carlsbad, Calif. Slightly more than half were assigned to the Panchakarma intervention (the Chopra Center’s Perfect Health program, which prices start at $2865 for a six-day treatment). The remainder to a relaxation control group. Blood plasma analyses, using liquid chromatography and mass spectrometry, were taken before and after the six-day testing period.

 

The researchers found that in the Panchakarma group there was a measurable decrease in 12 specific cell-membrane chemicals (phosphatidylcholines) correlating with serum cholesterol and inversely related to Type 2 diabetes risk.

 

“These phospholipids exert broad effects on pathways related to inflammation and cholesterol metabolism,” said Peterson. “Plasma and serum levels of the metabolites of phosphatidylcholine are highly predictive of cardiovascular disease risk.”

 

Application of a less stringent measurement standard identified 57 additional metabolites differentially abundant between the two groups of participants, which included additional phosphatidylcholines, sphingomyelins, and others. The authors suggested that given the very short duration of the trial, the serum profile changes were likely driven by the vegetarian diet component of Panchakarma. They said further studies were needed to more fully understand the processes and mechanisms involved.

 

Co-authors include Arthur M. Moseley, Joseph Lucas, Lisa St John Williams and P. Murali Doraiswamy, Duke University; Elizabeth H. Blackburn and Elissa E. Epel, UC San Francisco; Sheila Patel and Valencia Porter, UC San Diego and The Chopra Center for Wellbeing; Scott N. Peterson, Sanford Burnham Prebys Medical Discovery Institute; Eric E. Schadt, Steven R. Steinhubl and Eric J. Topol, Scripps Translational Science Institute; and Rudolph E. Tanzi, Harvard University.

 

Funding for this research came, in part, from the Fred Foundation, the MCJ Amelior Foundation, the National Philanthropic Trust, the Walton Family Foundation, the Chopra Foundation and Sybil Robson Orr.

 

Disclosures: Deepak Chopra is founder of the Chopra Foundation and co-founder of the Chopra Center for Wellbeing. Paul Mills is director of research at the Chopra Foundation.

 

Full study: Peterson, C. T. et al. Identification of Altered Metabolomic Profiles Following a Panchakarma-based Ayurvedic Intervention in Healthy Subjects. Sci. Rep. 6, 32609; doi: 10.1038/srep32609 (2016).