'Medical Mistakes': Beware of the mundane

Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes, by Robert Wachter, M.D., and Kaveh Shojania, M.D. Rugged Land. 320 pages. $24.95.

With its ominous cover and dramatic publicity material, a new book on medical mistakes hints at the scary material inside its pages: a woman who undergoes a cardiac catheterization meant for another patient, emergency room physicians routinely missing heart attacks and sending those patients home, an intensive-care nurse accidentally injecting her patient with a fatal dose of insulin.


But the fast-paced and compelling Internal Bleeding delivers a story far more complex -- and better -- than these simple plot lines suggest. Rather than attacking the mistakes as the blunders of untrained, lazy, or evil staff, the authors, who are both physicians, use their insiders' passes to tell a truth more horrifying: Many of these patients died because of the inevitable slips that happen in any workplace or home.

Given the culture of medicine and the way the system is set up, the authors argue, the mistakes that are killing thousands of patients every year are as predictable as someone forgetting to screw on the top of a salad dressing bottle.


Dr. Robert Wachter and Dr. Kaveh Shojania prove this point in case after devastating case, told with such precision and detail that one can't help but read on. The writers give a gritty sense of the reality in hospitals and emergency rooms, lacing their tales with medical lingo.

Rural doctors, for instance, sometimes refer to a regional teaching hospital as the "Big House," while deteriorating patients are described as "circling the drain." Internal Bleeding also weaves in the up-to-the-minute statistics, policy issues and politics. That makes it a must-read for anyone who works in the health-care arena.

But many readers may want to pick up this nonfiction book for another reason. It takes the high-tech, white-coated sheen off the world of medicine and brings it into the realm of the ordinary and the mundane. The authors show us that despite our perceptions, much of medicine isn't double and triple-checked. Basic steps that could immediately improve quality haven't happened yet. One patient can't get to the intensive care unit in time because of a broken elevator. Hospitals lack clear chains of command, so disputes between senior physicians in different specialties are often decided by the more forceful personality.

In a conversational and chatty tone, the authors share their own mistakes, fear and guilt. At times, their frustration and outrage at the lack of progress can barely be contained on the page. They describe how efficiently grocery stores have used bar-coding to label and track products, while less than 2 percent of hospitals have a similar system for medications.

But unlike others who have written about medical mistakes, these authors know the fear of physicians to report their mistakes, as well as the low priority that's been given to this issue. They compare medical mistakes to the early days of the AIDS crisis, before public pressure brought attention and research dollars.

The book's last chapters address what patients, doctors and policymakers need to do to make similar gains in patient safety. But in some ways, these sections aren't needed. The authors have already waked us up to the sad truth.

Diana Sugg has been a health reporter at The Sun since 1995, writing about trends, scientific breakthroughs and the human aspects of medicine. She won the 2003 Pulitzer Prize for beat reporting.