Sim labs are become more and more of a necessity in medical education. Especially as work hour rules are become more stringent, residents will not be able to be in the hospitals and clinics as much to see actual patients, so we will rely on their experience with sim patients from 8A-5P. This has benefits and risks- the benefits are instantaneous response and teaching in a controlled environment. The risks are- always learning in a controlled environment is nothing like being in the ER, or the ICU at 3:00AM when the poo is hitting the fan. We need to balance the sim and real environments so that the next generation of physicians can meet the expectations ahead of them.

My patient advocate saved my life in a major hospital in the Mid-West.

A patient on the next floor in a room directly above mine had the same first and last name. The only difference in our names was one letter in our first names.

My advocate (who stayed with me while checking in, waited through the operation, and stayed til my last night meds were given...each and every day I was there...and took me home) stopped every nurse who came in and read the meds and name and all other info relating to what I was to be given. She is the one who caught the mix-up in the drugs. I could've died had I been given the meds that were for the patient above me...which were delivered with a smile and a 'time for your medication'...chirp...chirp.

Yes. Some staff at the hospital were upset that she was there. But I had informed my doctor before hand that she would be there...Period. He backed me up...so long as she didn't interfere with my care. The seconds it took for her to check things out for me saved my life.

I will never go into a hospital willingly without a patient advocate. Nor will I not have said advocate's name and other information in my wallet and on the forms for the hospital.

This is the only life given to me, and I have to help protect it. It is all too clear that for too long both doctors and nurses have been treated as the be all and end all of our care. They are only human. Not gods.

As a nurse in an Intensive Care Unit at a busy hospital, all of these tips are very important. Don't be afraid to ask why we're doing something, a good doctor or nurse will be happy to tell you why. If you're not happy, ask for a different provider. These are your rights as a patient.

As an ER Nurse (currently working in a smaller,rural ED) I think the article covered some very good points. I feel it is as important to have trained and experienced nurses, especially in rural ED's as anything can and does walk in from ped's to delivery's to trauma, stemi's. Rural ED's commonly deal with farm type traumas that present to your facility via private vehicle. Unfortunatley I have noticed that Nursing administration is willing to short staff and float anyone to ED that has RN behind there name. Pt's should know how well qualified the nurse is taking care of them is and let administration know of there satisfaction or dissatifaction. Less errors would proably be made if the nurse had the experience and knowledge to question orders.

G-D, I have to be a freak'n doctor before I get sick? It seems like if I don't get some kind of certification before I go, I can't trust the staff to do what they're supposedly trained to do well.

With tens of millions more patients now entering the system, the responsibility rests more and more WITH THE PATIENT to be his/her own best knowledgeable observer and advocate.

The staff will be more and more overwhelmed.

Caveat emptor: Buyer beware

Equally important is for a patient or family to know the medical history. Please don't tell me you take a little pink pill for your heart or you don't know your meds and that Dr. So-an-so knows. At 3 am, I cannot call your pharmacy or or your doctor. Keep a list and give one to your family member. So many people have no clue yet expect the ER staff to figure it out.

Agreed, 98% of obstetric care proceeds without incident; however, as noted, when it goes bad it goes bad quickly and there MUST be a hierarchy of responsibility for decision making, management and supportive actions. There is no "FLAT HIERARCHY" in an emergency. Among nurses and doctors and other support staff there should always be mutual respect but, as in the military, one doesn't address the ultimately responsible member of the team by his first name, e.g. "Hey, general Bob, what are your orders for . . . ? or Airman, first class, "Hey, Sheri, should we fly that B-2 tonight?" A modicum of military type respect for "rank" should always be apparent on any hospital floor - not diefication at all - just a mutual HIERARCHICAL respect. THAT should be obvious on any floor of the hospital and patients should notice this. That, I think, would imply a properly tuned team of workers. After working shift, outside the hospital, it certainly is more fun with a flat hierarchical respect but definitely not within. It never works as well; patient beware.

*"Childbirth is like flying an airplane," says Dr. Wachter. "Most of the time it's straightforward. But when things go wrong, it turns chaotic fast. The outcome often depends on the level of communication." To gauge your crew's degree of teamwork, listen for gossip in the hall, note if doctors and nurses call each other by their first names, and trust your gut. You want a "flat hierarchy" of mutual respect, says Dr. Pronovost."

What utter rubbish! Would you want to be in a plane going down and have the captain ask a flight attendant what he should do about the starboard engine? Or be in a scenario when you are in an army unit under attack and have a private disobey an order and hear him call the Chairman of the joint Chiefs of Staff and say "Hey, Micky, don't like your strategy, so won't be obeying orders". Oh, and try going to a top restaurant with a "flat hierarchy" in the kitchen.

As, ask and ask. "Would you explain what that means, why I am being given that medicine, what that acronym means ?" All good medical personal should happily explain. If they won't call the nurse supervisor.

Writing "This is the wrong limb to cut Bozo" might work better than "cut here" if your surgeon need that much direction. Think about it.

If your parent is the elderly one, be there at discharge. Many elderly folks will sit there and say OK to whatever the doctor is telling them, with no clue or inclination to do it. Partly because they don't want to appear stupid, and partly because they grew up in a time where a doctor wasn't questioned. I've seen it happen, more than once in my own family. As an advocate, make sure to ask what happens if they DON'T follow the discharge directions.

This article is very unrealistic. If you asked many of these questions, you would be considered a troublemaker - and rightly so. Particularly all the central line IV ones. I feel sorry for the medical professionals having to deal with a patient like this, it would take forever to explain, answer all their questions, etc. On a larger note, I do not believe that medical mistakes are any higher than they were years ago, in fact I bet they are lower. I think it's a case of things hitting the media, like many other things that seem to be more prevalent these days (child abuse, stranger abductions, etc.). I do trust the medical establishment, I have seen all the redundancies they have in place to make sure errors do not occur. Sure, they still do - nothing will ever be perfect. But I believe they are exceedingly rare. And doing what the article suggests, paradoxically, will serve only to increase them because you have a bunch of patients who will not cooperate with what needs to be done in order to run a smooth operation.

Never take anything at "Face" value. If you are not capable of understanding the Dr's instructions then an advocate (friend,family member, associate) is not only recommended but paramount. NO medication should be given without Dr instructions and he should do this with YOU prior to administering anything. Ask questions. Only medicines that have been discussed face-to-face and affects/side affects reviewed. Nurses arriving at their shift may view old orders differently and become agitated when questioned; question anyway and refuse anything ; procedures, medicines or change in routine until a Dr has been consult by them AND you!! Some Nurses will prance in with a new "cocktail" of meds, some of which you have not discussed with the presiding Dr during daily rounds.Take nothing that you and your Dr have not discussed regardless of name on order or the order itself!!!

Questions to ask: Who is the admitting DR;? when are meals and rounds (the next time I expect to see the attending Physician or Hospitalist)? Remember the W's; What, Who, Where, When and last but not least Why. Why is left for last because it normally takes longer, more historical data and medical records reviewed, and family history evaluated. As the other questions surrounding the "event" come to light the "WHY" may become apparent. Try to keep it short and sweet because there are more of you than there are them and time is always important. But always question, or have questioned, and when not understanding demand otherwise. BUT, PLEASE, remember to say "THANK YOU" to your attendants as theirs is a often times thankless job dealing with ill/sickly people obviously not at their best. When they feel somewhat emotionally connected to you they may well take that extra step, speak up during rounds, and generally view your experiences different than most. It sounds simple, and is; but in this disconnected, FaceBook era where social graces are at an all time low it way serve well to remember to treat others the way you would wish to be treated, without the keyboard of course:)

So if no one will use a surgeon until he/she get's 50 operations, how do they get those 50?

Plastic dummies.

80,000 deaths a year? From medical mistakes? That's intolerable! Hospitals should be banned.