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When We Do Harm

A Doctor Confronts Medical Error

Author: Danielle Ofri

Medical mistakes are more pervasive than we think. How can we improve outcomes? An acclaimed MD’s rich stories and research explore patient safety.

Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable. In When We Do Harm, practicing physician and acclaimed author Danielle Ofri places the issues of medical error and patient safety front and center in our national healthcare conversation.

Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error. Woven throughout the book are the powerfully human stories that Dr. Ofri is renowned for. The errors she dissects range from the hardly noticeable missteps to the harrowing medical cataclysms.

While our healthcare system is—and always will be—imperfect, Dr. Ofri argues that it is possible to minimize preventable harms, and that this should be the galvanizing issue of current medical discourse.
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“What makes this book special is Ofri’s perceptive and compassionate nature; she sees her own patients as real people and is candid with readers about her concerns and vulnerabilities. . . . Thorough analysis of a challenging problem executed with a personal touch that makes it highly readable.”
Kirkus Reviews, Starred Review

“An essential read for anyone involved or interested in the care of patients.”
Booklist

“Anyone familiar with Dr. Danielle Ofri’s books or blogs knows that she is in the company of other physician writers who share a deep commitment to ensuring that humanity is always at the heart of healthcare. Her readers know, too, that she is a skilled and compassionate healthcare provider.”
New York Journal of Books

“This book is a must read for anyone entering a hospital as a patient, and for family members and patient advocates. Doctors, nurses, and hospital administrators will also benefit. It should be required reading in nursing and medical schools.”
Medium

“One of the leading physician-authors of our time, Danielle Ofri masterfully diagnoses the reasons for our pervasive problem of medical errors. Beyond a systematic dissection that every patient can understand, she provides solutions for how to get healthcare on track.”
—Professor Eric Topol, author of Deep Medicine

Praise for Dr. Danielle Ofri

“The world of patient and doctor exists in a special sacred space. Danielle Ofri brings us into that place where science and the soul meet. Her vivid and moving prose enriches the mind and turns the heart.”
—Jerome Groopman, author of How Doctors Think

“Danielle Ofri is a finely gifted writer, a born storyteller as well as a born physician.”
—Oliver Sacks, author of Awakenings

“With the meticulous care of Oliver Sacks and the deep humanism of Atul Gawande, Danielle Ofri . . . presents compelling evidence that even as doctoring appears to be dominated by technology, the human, affective relationship is at the very center of responsible practice.”
—Andrew Solomon, author of Far from the Tree

“[Ofri offers] taut, vivid prose. . . . She writes for a lay audience with a practiced hand.”
—Katie Hafner, New York Times

“Ofri adroitly balances presentation of her own experiences and those of others. . . . Her voice is one that deserves to be heard and listened to carefully, as what she describes carries great significance for all of us within the health care system, patients and healers alike.”
—Dennis Rosen, The Boston Globe

“Danielle Ofri has so much to say about the remarkable intimacies between doctor and patient, about the bonds and the barriers, and above all about how doctors come to understand their powers and their limitations.”
—Perri Klass, MD, author of A Not Entirely Benign Procedure

CHAPTER ONE
Jumbo Jets Crashing

CHAPTER TWO
A Sea of Uncertainty

CHAPTER THREE
Making—or Missing—the Diagnosis

CHAPTER FOUR
The Fever

CHAPTER FIVE
Diagnostic Thinking

CHAPTER SIX
The Descent

CHAPTER SEVEN
For the Record

CHAPTER EIGHT
The Human Consequences

CHAPTER NINE
On the Clock

CHAPTER TEN
What You See

CHAPTER ELEVEN
I’ll See You in Court

CHAPTER TWELVE
Is There a Better Way?

CHAPTER THIRTEEN
Looking for Answers

CHAPTER FOURTEEN
Bringing Along Our Brains

CHAPTER FIFTEEN
The Reckoning

CHAPTER SIXTEEN
So What’s a Patient to Do?

CHAPTER SEVENTEEN
Getting It Right

Acknowledgments
Notes
Index

When We Do Harm: A Doctor Confronts Medical Error by Danielle Ofri, MD

Readers’ Guide Discussion Questions

Download the readers’ guide.
  1. Why do you think Dr. Ofri decided to write this book? Why might this book be important for both casual readers and those in the medical field?
  2. We all expect the medical system to take care of us and not cause harm. However, as the author mentions, medicine is a human profession. People are fallible and subject to uncertainty. How do you—as a potential patient—grapple with that reality?
  3. The media shapes how we view and interact with issues. In what ways has the media driven the call for change of the medical system? How might it also have done harm?
  4. Efficiency is typically viewed as beneficial, but when might it become detrimental? Have you had experiences where a focus on efficiency has caused unintended consequences?
  5. Healthcare is urged to take safety lessons from the aviation industry. In what ways is this a fair—or unfair—comparison?
  6. Although money isn’t explicitly discussed much in the book, it is hinted at in several places. Tara wonders if Jay wasn’t transferred to the ICU because of financial issues. Nancy has a similar thought about Glenn’s delayed transfer to the burn center. How much of a role do you think money plays in clinical decisions by doctors, nurses and hospitals?
  7. Dr. Ofri profiles two major pillars of the Danish approach to medical error. All adverse events (even ones that aren’t errors) are reported to a national database, and these reports cannot be used against any medical professional. Separate from this, any patient can apply for compensation for medical care that harmed them (without having to get a lawyer or file a lawsuit.)
    1. From a patient’s perspective, what are the pros and cons of the Danish and the American systems?
    2. What about from a doctor’s perspective?
    3. What about from the perspective of society, in terms of making the healthcare system safer overall?
  8. Both Tara and Nancy filed lawsuits over the medical care their husbands received. Do you think lawsuits achieved the goals Tara and Nancy were pursuing? What do you think was the effect of the lawsuits on the hospitals and the individual doctors, nurses, and administrators?
  9. There are many nurses featured in this book, most as key patient-care advocates but a few—as in Jay’s medical care—who did not stand up to the system. How does our society view nurses? How does this compare to how it views doctors?
  10. Is there a “gold standard” when it comes to practicing medicine? How might the notion of a gold standard serve—or not serve—patients, especially when they are facing a possible medical error?
  11. How might bias and discrimination contribute to medical errors? How might the healthcare system root out bias? Do you think it’s possible?
  12. If you have experienced medical error or know someone who has, does this book change how you view the experience?
  13. Dr. Ofri offers several different ways to potentially minimize error, from training simulations to patient preparedness to the implementation of artificial intelligence into diagnostics. Do you think these can make a practical dent in the system, or will they just nip at the edges? Do you have any other ideas that might help the system?

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When We Do Harm

ISBN: 978-080703788-1
Publication Date: 4/21/2020
Size:6 x 9 Inches (US)
Price:  $24.95
Format: Cloth
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