HAVRE DE GRACE, MD – After noticing several readmissions for falls, double-digit INRs, and recurrent nonischemic chest pain, hospitalists at Harford Memorial Hospital realized that an insidious killer was stalking the elderly patients in this quiet town: iatrogenic injury.
“At first it seemed harmless,” said Dr. Hulga Hopewell, an internist at the hospital. “We were just trying to make sure every patient who had delusions was put on a therapeutic dose of Seroquel and every tiny pulmonary embolus seen on chest CT got anticoagulated. But when people kept coming back in worse off than before, we realized that there just wasn’t enough awareness about this problem.”
She decided that something had to be done and, being an avid runner, a 5K Fun Run was the best way to get the word out and raise funds to support research to find a cure. “Walking or running is a great way to improve your health and to let people know that this is a big issue.”
“My mother had a really good relationship with her doctor for years,” said local resident John Pincussin. “Growing up, she relied on the ‘little helper’ he prescribed her to deal with me and my siblings. But as she got into her sixties, we all started to wonder if 15 milligrams of Valium twice a day was making her tired, especially when she was also taking Flexeril, gabapentin, oxycodone, and Lyrica for her chronic pain. When she fell twice in the same week and went to the ER each time, she got a full-body CT scan each time and cipro for a possible UTI. Those didn’t help at all. But then Dr. Hopewell realized that she probably needed to cut back a little on her meds, and she hasn’t been this peppy since the ’70s!”
The concern has even reached the level of hospital leadership. Dr. John Overtreat, CEO, reflected on the hospital’s growing concern for preventing and treating iatrogenic injury by saying, “It used to be that when patients got C. diff after receiving massive doses of antibiotics in the hospital, we simply accepted it and the money that came along with treating a sicker patient for a longer time in the hospital.”
Some physicians question the utility of getting all worked up about more extensive workups. ER physician Dr. Sam Testalot told reporters he didn’t want to risk missing that 0.01% rare disease. “No one’s ever been sued for doing too many head CTs, and by the time they get cancer from the radiation, well that will be years from now.”
When asked about the effect that this campaign against iatrogenic injury might have on patient satisfaction, Dr. Hopewell pointed out recent data suggesting that increased patient satisfaction is an independent predictor for mortality.
Combating morbidity and mortality from iatrogenic injury won’t be an easy fight. But this all-American town is prepared to take on the challenge. They’re even discussing getting actual patients from the hospital to join the Fun Run, while staying in their hospital beds, of course.
“We’ll have someone pushing the elderly patients on the Fun Run,” said Dr. Overtreat, who will be at the front of the race. “We wouldn’t want any elderly patients getting out of bed and possibly falling while they’re inpatients, would we? Iatrogenic injury at the Iatrogenic Injury Awareness fun Run just doesn’t sound like a good idea.”
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