For the past 15 years, technology was touted as the cure for the problem of medical mistakes. And since healthcare has gone digital over the past few years, it has prevented many errors. But surprisingly, even shockingly, we have learned that healthcare technology can also cause errors – some of them breathtaking.
This week, Dr. Robert Wachter continues to reveal the deep insight within his new book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.” A series of five excerpts being run on the popular blogging site Medium captures the power of this revelatory and widely praised book and the drama of the collision of the worlds of medicine and technology. The excerpts describe a remarkable case of a medical mistake, “Harm in a Wired Hospital.” From Day One:
At 5:32 a.m., Brooke Levitt heard a scream coming from Pablo’s room. It was Blanca Garcia. A few seconds earlier, her son had sat bolt upright in bed, yelled out “Mom!” then flopped backward. Levitt sprinted to the room, and when she got there, Pablo’s head was snapping back and forth, teeth clenched, back arched, extremities thrashing. He was having a grand mal seizure. Moments later, just as the Code Blue team arrived, the teenager stopped breathing.
“I thought, what if I killed him?” Levitt told me months later, wiping away tears. “If he had a seizure, I’m wondering if that’s going to be the end of it…I’m trying to hold it together, but I’m in shock the whole time. I just felt immensely guilty.”
Other industries – ones in which technology entered gently and spread organically over time – gradually came to appreciate the complex interface between technology and people, and worked to overcome many of the potential hazards. I have no doubt that, even in these awkward early days, digital medication safety systems … prevent more errors than they cause, and they will surely get better over time as both the technologies and the processes around them mature. But now that healthcare has entered the computer age, the night that Pablo Garcia was given a 39-fold overdose of a routine antibiotic offers a cautionary tale that cannot be ignored.
The five-part series will run through Friday, April 3, on Medium.com. To catch up on and follow the popular series, which has been viewed more than 50,000 times in its first two days, click below. For more news on the book, use hashtag #DigitalDoc.
Day One: How Medical Tech Gave a Patient a 39-Fold Overdose
Day Two: Beware of the Robot Pharmacist
Day Three: The Self-Driving Hospital
Day Four: Should Hospitals be More Like Airplanes? (coming tomorrow, April 2)
Day Five: The Aftermath (coming Friday, April 3)