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Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes | 
 enlarge | Authors: Robert Wachter, Kaveh Shojania
Publisher: Rugged Land
Category: Book
List Price: $24.95
Buy Used: $0.51
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Rating:  20 reviews
Sales Rank: 418144
Media: Hardcover
Pages: 448
Number Of Items: 1
Shipping Weight (lbs): 1.6
Dimensions (in): 9.1 x 6.2 x 1.2
ISBN: 1590710169
Dewey Decimal Number: 610
EAN: 9781590710166
ASIN: 1590710169
Publication Date: February 7, 2004
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Condition: SOME PASSAGES HAVE BEEN HIGHLIGHTED (Airport Place Books does not ship on Saturdays and Sundays. We are unable to ship to "The Republic of Korea".)
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Amazon.com Review
With a mix of horrifying medical accidents and warmly logical problem solving, Internal Bleeding provides a serious, if graphic, look at an industry where a simple mistake can lead directly to death. Happily, authors (both are medical doctors) Robert Wachter and Kaveh Shojania have as many practical solutions as they have tragic errors. Generally based on updated systems and protocols in processes like computerized prescription writing and physically initialing specific body parts to be operated on, their solutions are both sympathetic and angry. Pointing out impatient, overworked or generally stubborn doctors and nurses that are resistant to changing procedures, they also are quick to detail the overwhelming combination of low funds and the drive for profit that keep hospitals from always providing the optimum working (and healing) conditions. Most helpful to nervous patients (and you'll almost certainly be nervous after reading this) is a short chapter offering advice on how to insure you're well informed on all aspects of your health care. While the language--and solutions--presented are often complex, the knowledgeable, personal slant provided by both authors lends a new perspective to the continuing debate between abstract policies and daily practices in health care. --Jill Lightner
Product Description
Imagine an epidemic that kills over one hundred Americans every day. Now stop imagining.
Each year doctors and nurses kill nearly one hundred thousand Americans. By mistake. They operate on the wrong patients, prescribe the wrong drugs, and leave instruments inside body cavities after surgery. Meanwhile, hospitals spend billions on new gadgets, marble lobbies, and slick billboards even as safety continues to be ignored.
Until now.
Internal Bleeding exposes the dark secrets behind the glistening facade of modern medicine. Doctors Robert Wachter and Kaveh Shojania, professors at one of America's leading medical schools and two of the world's foremost authorities on medical mistakes, shatter the silence to tell the dramatic and compelling stories of real patients betrayed by a system they trusted to save them.
Through these stories, the authors reveal the inner workings, gut-wrenching dilemmas, and heartbreaking tragedies of our overburdened, understaffed health care system. Internal Bleeding provides an insider's view of how professional caregivers think, feel, and operate-facts that every patient and family must know to avoid becoming just another "mistake."
In the groundbreaking tradition of Fast Food Nation, Internal Bleeding paints a vivid and unforgettable picture of a system gone terribly wrong, and what doctors, nurses, hospital CEOs, and policy makers must do to make it right.
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| Customer Reviews: Read 15 more reviews...
Horror story June 14, 2008
JBeary (LA, Calif)
When you're in the hospital if you think docs are going to do every thing they can to save your life, you're may be dead wrong.
The majority of docs and hospital workers resist every new quality program that can improve outcomes. Look how low the adoption of six sigma is in healthcare. Most of the major quality control programs created in industry are absent in hospitals. Often the programs they have run at such a low level they don't provide much benefit.
Do some research and find out how many errors are made that kill people in hospitals. Estimates range between 100,000 and 250,000 deaths per year, and that doesn't include those that are injured or crippled up.
If somebody makes a mistake in Iraq and 3 soldiers are killed, it's national news and every politician is calling for somebody's head. Kill a 100,000 people in the hospital every year with mistakes, who cares.
Yes, there are a few people who are trying to fix the problems, but not enough are trying. Half the time hospitals don't even know how to measure outcomes, errors and problems. A lot of hospitals use bogus quality programs to tout how they comply with xyz blah, blah, blah, but the truth is these programs have little or no impact on errors, mortality or morbidity.
This book is a good place to start if you're interested in the subject.
60,000 people killed in auto accidents every year, more than 100,000 killed annually in hospital accidents, why aren't the politicians screaming and hollering about those dead bodies? Well, it doesn't get them any votes!
"Culture Eats Strategy For Lunch." May 27, 2008
Robert I. Hedges
1 out of 1 found this review helpful
"Internal Bleeding" is a good primer on medical culture. The authors focus on the issues related to medical errors. The book is largely well written, but occasionally the authors resort to hyperbole to make points; terms like "crisis" and "epidemic" are occasionally warranted, but their overuse tends to occlude important nuances within the issues discussed.
I was particularly interested in the analogies the authors made to the aerospace field, and found the cultural comparisons insightful. The discussion of the space shuttle accidents (pp. 49-51) are a proper indictment of NASA management, and makes the argument that in medicine and aerospace as well, taking routinely good outcomes as positive reinforcement of perceived infallibility is asking for disaster. ("NASA had forgotten how to be afraid.") On pp. 88-89 the authors discuss the differences between "slips" and "mistakes" and include a valuable commentary on trapping errors, much like the latest iteration of aviation training attempts to trap errors with "Threat and Error Management".
The authors provide excellent commentary on the makings of master diagnosticians, hypothesis testing, and the applicability of Bayes' theorem to medical reasoning on pp. 110-112 and p.117. This section provides an excellent view into the minds of doctors as they make challenging evaluations in complex cases: although not specifically stated at this point, similar thought processes are used in other highly skilled, tightly-coupled professions, such as aviation. The authors also explain why overreliance on automation and underreliance on physician wisdom is certain to result in bad medicine, despite the utility of computer systems in medicine. ("Any doctor who could be replaced by a computer should be.")
The authors return to their aviation subtext on p.147 in their discussion of pilot selection versus medical school selection; the conclusion reached is that the real-world evaluations given to pilot candidates would be a much better template for medical school applicants than what is currently used. On pp.156-157 the authors discuss doctors as being psychological perfectionists, and provide examples from other professions which tend to validate their hypothesis. The crux of the discussion is the intolerance for mistakes within the profession and within the psyche of individual surgeons, a trait common to pilots. Furthering the discussion of error-intolerance is a discussion (p. 176; p. 366) of one of the most common types of errors in both aviation and medicine: communications and the handoff error, a theme that is common throughout the remainder of the book. The authors make clear that while pilots are lauded for soliciting input from others (it wasn't always so), surgeons are known for being exceedingly inflexible (p. 191; p.222) to the detriment of the patient. When coupled with communication issues and power-distance problems, inflexibility is not a desirable trait in a surgeon. On pp. 222-224 there is an informative discussion of the roles of communications in both medical and aviation errors, concluding with a recounting of the worst aviation accident in history at Tenerife, which was caused largely by communication problems.
All of chapter 20 is laudable as it really distills the culture of safety concept down to the essentials. Notably, pp. 348-349 discusses the potential usefulness of Failure Mode and Effects Analysis, a longstanding aviation tool, in medicine, while p. 351 serves to recap the aviation safety from a historical vantage point.
Finally, the authors detail one of the most potentially beneficial changes that could be made in American healthcare (pp. 342-343) where they discuss the advantages of a no fault system of compensation for victims of bad healthcare.
This book is really a study of safety systems in a hospital environment, with relevant discussions of other germane industries (especially aviation) throughout. It is not a dry, academic tome; it is quite accessible to anyone who is interested in healthcare in the US. I recommend the book for safety professionals in any field, to physicians and medical professionals, and to anyone else with an interest in curbing errors in medicine. No book is perfect, but "Internal Bleeding" does cover the most salient points in the dialogue that is taking place (or should be taking place) in hospitals across the country.
 A Must Read for All Medical Employees March 30, 2007
Imber Coppinger (Athens, Ohio)
1 out of 1 found this review helpful
This is a top notch book required for all our first year medical students. It will change the way you think about medical mistakes. Guarenteed to save lives . . .Not only that, but it reads like a thriller novel, so you get all the benifit while it feels like you're goofing off!
Dr. Imber Coppinger, 15 years in medicine
Internal Bleeding March 13, 2007
Debra Howard
1 out of 1 found this review helpful
Excellent book for both the medical field and lay people alike.
Great ideas for improving health care in the USA.
 self-serving doctors write book July 9, 2004
steve (nyc)
11 out of 41 found this review helpful
Why their way is the best way. I suggest you read What your doctor Won't Tell You. This is a gutsy non self-serving and tell all book that will help you get through our terrible health system
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