Welcome to the Society for the Suppression of Curiosity

By Deepak Chopra, MD

The secular world is built upon science, which overturned the world of faith. Exchanging spiritual beliefs for objective facts looks like a clear-cut choice, but it isn’t. In all our lives there are values like compassion and loving kindness that are not scientific, and so everyday life straddles two worlds. In one world having a compassionate heart means something important. In the other compassion has no meaning unless it can be reduced to data on a brain scan.

A mature person can live in both worlds comfortably, because they don’t need to clash. Dr. Francis Collins is a physician and geneticist who is the head of the National Institutes of Health, but he also happens to be a devout Christian who has written movingly about his religious awakening. Besides straddling two worlds, which we all do, Collins has explored them both, in keeping with his bent for inner and outer discovery.

Yet some religionists can only tolerate one view of life, and they insist on fundamentalist beliefs, such as the belief that God created human beings in their present form, and reject all scientific claims to the contrary. In the other world, some science-minded people cannot tolerate faith and mystery, and they reject any thing that cannot be proven as experimental fact.

In both cases, there is a total suppression of curiosity and a rigid insistence on “right think,” to adopt the Orwellian term for beliefs enforced by punishment from higher up.

Recently, in the wake of a widely admired speech at the Golden Globes supporting the #metoo movement, Oprah Winfrey was attacked in several quarters for being a supporter of pseudoscience. The outlets for these attacks varied from outright personal smears to more detached reportage , and the outlets for the stories ranged widely on the right and left, form the New York Post to the Washington Post, even reaching the online website, Physics Today.

Some of these stories fell under the category of vetting a celebrity who supposedly has ambitions to run for President, and that’s legitimate. If Oprah believed in something as far-out and anti-scientific as creationism, the public has a right to know. But quickly the attacks exposed a streak of suspicion from pro-science skeptics who militantly believe that any attempt to straddle two worlds must be condemned. The society for the suppression of curiosity got on its hind legs.

Oprah is perfectly capable o defending herself, but I’d like to address the larger issue (motivated not least because my name was occasionally brought up as someone she has promoted. I actually appeared on the Oprah Winfrey Show exactly once, in 1992, and 20 years later we became colleagues in promoting online meditation courses, whose profits in my case go to support a non-profit foundation).

One charge against Oprah is that she promoted the careers of two men, Dr. Oz and Dr. Phil, who went on to become celebrities in their own right. Holding her responsible for their views is clearly unfair. Both have been public figures for more than a decade and are responsible for their own views. Both are qualified in their field, Mehmet Oz as a cardiothoracic surgeon, Phillip McGraw as a PhD. in psychology. What they have promoted or espoused is up to them, not Oprah.

What really galls her critics is much more general, an openness to ideas not acceptable to some scientists. This opposition gets inflated, depending on your degree of intolerance, to blaming her for the promotion of junk science, quackery, charlatanism, etc.–you can always spot the irrationality of skeptics by their quick descent into hyperbolic rhetoric. There is a tradition in progressive societies to tolerate fringe ideas, based on the belief that people can make up their own minds about truth and untruth.

When skeptics align themselves against this tradition, they believe they are advancing science when in fact they are advancing close-mindedness. It isn’t necessary to come to the defense of every guest Oprah has had on her show. There have been advocates for notions like the danger of vaccinations whose positions absolutely run counter to accepted medical knowledge. But right or wrong, they deserve to speak freely. Then it’s up to public debate to decide the issues.

Oprah has gained her influence by being open-minded (among other things), and I know first-hand what it takes to advance something like meditation, an object of ridicule among skeptics thirty years ago, or the mind-body connection, scorned by mainstream medicine when I first went into practice, or the notion of personal spiritual growth, which arouses splenetic outrage from militant atheists.

Oprah willingly took on the role of inspiring her viewers and informing them. She has been a lighthouse and a lightning rod, which is inescapable when you step outside the box of social conformity, accepted dogma, conventional wisdom, and right think. The current spate of attacks is a kerfuffle that will pass. But whenever the society for the suppression of curiosity goes on the attack, it should be examined with the same skepticism that it advocates.

Deepak Chopra MD, FACP, founder of The Chopra Foundation and co-founder of The Chopra Center for Wellbeing, is a world-renowned pioneer in integrative medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism.  He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. Chopra is the author of more than 80 books translated into over 43 languages, including numerous New York Times bestsellers. His latest books are Super Genes co-authored with Rudy Tanzi, Ph.D. and Quantum Healing (Revised and Updated): Exploring the Frontiers of Mind/Body Medicine.  www.deepakchopra.com

A Better Answer to Chronic Stress

By Deepak Chopra, MD and Rudolph E. Tanzi, PhD

If an epidemic is defined as a disease that affects whole populations without having a medical cure, then the epidemic of modern life is stress. Itself not a disease, stress instead leads to a breakdown in the body’s internal balance, or homeostasis, and from that point onward, if the stress isn’t relieved, damage occurs from within. Ironically, most modern people in a developed country do not experience acute stress, the kind that triggers a full-blown fight-or-flight response. There is no battlefront, civil war, rampant violent crime, or struggle over food and water to contend with.

Our epidemic is silent and hidden, in the form of low-level chronic stress. The natural purpose of the body’s stress response is to trigger heightened alertness and energy for a short period, a matter of minutes or at most an hour, when fighting or fleeing is a matter of survival. When stress becomes chronic, a “normal” way of life that people believe they have adapted to, stress hormones become a drip-drip in the background of the physiology, and over time, three stages of damage begin to appear:

Psychological and neural damage, which begins with minor things like feeling mentally tired and under pressure from deadlines at work. When people say they are stressed out, they generally mean that they’ve run out of energy, which can mask mental states like being depressed, anxious, or even panicky.

The next stage is behavioral. Negative changes in behavior are likely to manifest in two major areas, work and relationships. Stressful jobs make us respond with all kinds of behaviors, from office gossip to going out for a drink after work. As stress mounts, the drinking can get heavier, the need for distraction more severe. Inevitably we take our feelings home after work, where friction easily follows.

Eventually chronic stress leads to physical damage. When the body can’t completely adapt to stress, bad effects follow without being predictable. Most people will suffer from physical fatigue. Stomachaches, bad digestion, and headaches are likely. So is reduced immune response, leading to more colds and worsened allergies. After that, the problems will tend to be associated with inflammation, whose effects can travel anywhere. One person may experience skin eruptions, another irritable bowel syndrome, yet another a heart attack or stroke. By this stage, the damage caused by stress has led to serious system breakdown.

In our latest book, The Healing Self, we go into great detail about how to personalize your own stress-reduction program. But for everyone, there need to be conscious coping mechanisms in the face of everyday stress. Let’s say you’re at the airport and find out that your flight has been canceled. The airline won’t bring another airplane into service but tells you that you must wait five hours until a flight arrives that can accommodate you. With no alternative except to comply with the airline’s mistreatment, passengers look passive as they sit and wait, but on the inside many people will react (perhaps you) with the following responses: worry, complaining, and pessimism. All are self-defeating.

Worry is self-induced anxiety. It solves nothing and blocks the possibility of dealing with things more positively.

Complaining increases tension and anger. As a display of hostility, it encourages other people to act hostile in return.

Pessimism induces the illusion that a situation is hopeless and fosters the belief that expecting a bad outcome is always realistic, when in fact it isn’t.

If you see yourself in any of these behaviors and attitudes, you are fooling yourself into believing that you are adapting to stress. As your body experiences it, however, you have become the stressor yourself. That’s because an external event (canceled flight) must go through an internal interpretation before it triggers the stress response. Unlike a crisis like losing your job, a flight delay belongs in the category of everyday chronic stresses. Which means that you have a choice to respond. Worry, complaining, and pessimism are unconscious responses. People who are stuck in them have become the victims of old reactions that became glued in place because the person didn’t reevaluate them.

Some people handle a canceled flight better than others. Just as we gave you the “baby solution” for acute stress, here’s the “airport solution” for low-level everyday stress.

The “Airport Solution” to Chronic Stress


Detach
yourself from the stressor. At the airport people do this by reading a book or finding a place to be alone.

Become centered. At the airport people do this when they shut their eyes to meditate.

Remain active. At the airport this means walking around instead of slumping in a chair and waiting.

Seek positive outlets. At the airport this might mean shopping, getting a chair massage, or going to a restaurant.

Rely on emotional support. At the airport the usual way to do this is by calling a friend or family member on the phone. (A short call announcing that you’ll be late won’t give you emotional support. The key is a conversation with someone meaningful in your life that lasts at least half an hour.)

Escape if you must. At the airport, if the airline’s behavior gets too outrageous, it saves your psychology to reschedule and go home. (Of course this not always practical or affordable.)

All of these things are positive adaptations, as opposed to the negativity of worry, complaining, and pessimism. They bring awareness into a situation where falling back on passive acceptance isn’t the right answer. Beneath the attitude of “I have to put up with it” lies stress. In most everyday situations you have the option of turning the situation around by interpreting it not as bad luck but as a non-stress, to which you respond by doing things you actually want to do, like meditating, connecting with a friend, or shopping. When you become adept at this turnaround, chronic stress is nipped in the bud. You cut short a process that otherwise would have affected your body and mind negatively.

Deepak Chopra MD, FACP, founder of The Chopra Foundation and co-founder of The Chopra Center for Wellbeing, is a world-renowned pioneer in integrative medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism.  He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. Chopra is the author of more than 80 books translated into over 43 languages, including numerous New York Times bestsellers. His latest books are Super Genes co-authored with Rudy Tanzi, Ph.D. and Quantum Healing (Revised and Updated): Exploring the Frontiers of Mind/Body Medicine.  www.deepakchopra.com

Rudolph E. Tanzi, Ph.D. is the Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard University and Vice Chair of Neurology at Mass. General Hospital. Dr. Tanzi is the co-author with Deepak Chopra of the New York Times bestsellers, Super Brain, and Super Genes. He is also an internationally acclaimed expert on Alzheimer’s disease and brain health with over 500 research publications. He was included in TIME Magazine’s “TIME 100 Most Influential People in the World.”

Fighting a Hidden Enemy: Inflammation

By Deepak Chopra, MD and Rudolph E. Tanzi, PhD

 

Inflammation has always been a medical mystery, but now it has become an enemy of long-term health. On the one hand, when your skin turns red, swollen, and painful after you burn yourself, which triggers acute inflammation, the response is normal and beneficial. Extra red blood cells, immune cells, and anti-oxidants are rushing to the wounded site to heal it. But carried too far, inflammation can be fatal, as when someone is too burned to recover.

 

Only in the past few decades has it dawned that low-level chronic inflammation, which usually goes completely unnoticed plays a part in many lifestyle disorders such as hypertension, heart disease, cancer, and Alzheimer’s. Chemicals known as inflammation markers can enter the bloodstream in various ways: from the intestinal tract (so-called leaky gut), as a reaction to infection, or through the action of the immune system in other internal ways. The slow drip, drip of inflammatory markers can take years to create major impairment, which means that each person must tailor his lifestyle to counter them.

Diet alone isn’t enough to keep chronic low-level inflammation at bay, but it’s a good start. By adopting an anti-inflammation diet, you aim at two positive results: keeping the micro-organisms in your intestines healthy and flourishing, and thereby preventing the seepage of toxic chemicals into the bloodstream. There is also the indirect benefit that a healthy digestive system sends signals of wellbeing along the vagus nerve to the heart and brain.

The millions of bacteria that inhabit the intestinal tract are an essential part of our total DNA, contributing thousands of separate genomes. Together this vast colony is known as the microbiome. Here are some essential points to know.

  • The gut microbiome is different from culture to culture. In each of us it is constantly shifting in response not just to diet, but to stress and even emotions.
  • Because of its genetic complexity, a “normal” gut microbiome hasn’t been defined yet.
  • It is generally believed, however, that a flourishing, healthy gut microbiome is founded on a wide range of natural foods rich in fruits, vegetables, and fiber.
  • The modern Western diet, which is low in fiber but high in sugar, salt, fat, and processed food, may be seriously degrading the gut microbiome.
  • When the gut microbiome is damaged or degraded, bacteria begin to release so-called endotoxins—the by-products of microbial action. If these toxins leak through the intestinal wall into the bloodstream, markers for inflammation are triggered and persist until the toxins are no longer present.

In our new book The Healing Self, we give complete details about setting up your own personalized antiinflammation diet. You can start by adopting individual changes, working up to a complete regimen.

 

We divide our advice into Do (adding something good to your diet) and Undo (taking something bad out of your diet). We tell people to choose only one change at a time, seeing how well they can follow it, and only then moving on to the next change.

DO

Add some anti-inflammatory foods to your diet (see below).

Include more organic food to your grocery shopping.

Increase the fiber in your diet.

Take a probiotic supplement (widely available a health food stores).

Switch to olive or safflower oil.

Drink coffee 1-5 times a day.

 

UNDO

Cut down sharply on your sugar intake.

Cut out junk food and fast food.

Throw out stale food, including stale cooking oils and leftovers more than a day old.

Reduce overall fat intake.

Reduce salt intake.

Use no alcohol or at most one drink a day (there is some evidence that a single drink is anti-inflammatory while adding more alcohol is definitely inflammatory).

A natural, organic, whole-food diet should be maintained over a lifetime to keep low-level inflammation at bay, but nutritional research has uncovered specific foods that have anti-inflammatory properties.

 

Foods That Fight Inflammation

Fatty cold-water fish (such as salmon, tuna, mackerel, herring)

Berries

Tree nuts (such as walnuts, almonds, hazelnuts, etc., but excluding peanuts, a groundnut)

Seeds

Whole grains

Dark leafy greens

Soy (including soy milk and tofu)

Tempeh

Mycoprotein (from mushrooms and other fungi)

Low-fat dairy products

Peppers (e.g., bell peppers, various chilies—the hot taste isn’t an indication of inflammatory effects in the body)

Tomatoes

Beets

Tart cherries

Ginger and turmeric

Garlic

Olive oil

In their online health publications, Harvard Medical School adds a few other items to the list:

Cocoa and dark chocolate

Basil and many other herbs

Black pepper

Other listings add the following:

Cruciferous vegetables (cabbage, bok choy, broccoli, cauliflower)

Avocados

Hot sauce

Curry powder

Carrots

Organic turkey breast (substitute for red meats)

Turnips

Zucchini

Cucumbers

Leaving aside their anti-inflammatory effects, these are all healthy, whole foods, and making them a mainstay of your diet can only be beneficial. However, the science is still out on whether all of these foods actually have an anti-inflammatory effect in the body, and also what effect, if any, they have on the microbiome. Still, fighting chronic low-level inflammation isn’t incidental or just one in a long list of positive lifestyle changes. It could be the key, along with stress reduction, to enjoying wellness for many decades into a healthy old age. There is every reason to go down this road and no reason not to.

Deepak Chopra MD, FACP, founder of The Chopra Foundation and co-founder of The Chopra Center for Wellbeing, is a world-renowned pioneer in integrative medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism.  He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. Chopra is the author of more than 80 books translated into over 43 languages, including numerous New York Times bestsellers. His latest books are Super Genes co-authored with Rudy Tanzi, Ph.D. and Quantum Healing (Revised and Updated): Exploring the Frontiers of Mind/Body Medicine.www.deepakchopra.com 

 


Rudolph E. Tanzi, Ph.D. 
is the Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard University and Vice Chair of Neurology at Mass. General Hospital. Dr. Tanzi is the co-author with Deepak Chopra of the New York Times bestsellers, Super Brain, and Super Genes. He is also an internationally acclaimed expert on Alzheimer’s disease and brain health with over 500 research publications. He was included in TIME Magazine’s “TIME 100 Most Influential People in the World.”

 

How to Be Your Own Medical Advocate

By Deepak Chopra, MD and Rudolph E. Tanzi, PhD

When the average person goes to the doctor, shows up at the ER, or enters the hospital, the possibility of controlling what happens next is minimal. We put ourselves in the hands of the medical machine, which in reality rests upon individual people—doctors, nurses, physician’s assistants, and so on. Human behavior involves lapses and mistakes, and these get magnified in medical care, where misreading a patient’s chart or failing to notice a specific symptom can be a matter of life and death. The riskiness of high-tech medicine like gene therapy and toxic cancer treatments is dramatically increased because there is a wider range of mistakes the more complex any treatment is. To be fair, doctors do their utmost to save patients who would have been left to die a generation ago, but they are successful only a percentage of the time.

Risk and mistakes go together, but the general public has limited knowledge of the disturbing facts:

  • Medical errors are estimated to cause up to 440,000 deaths per year in U.S. hospitals alone. It is widely believed that this figure could be grossly inaccurate, because countless mistakes go unreported—death reports offer only the immediate cause, and many doctors band together to protect the reputation of their profession.
  • The total direct expense of “adverse events,” as medical mistakes are known, is estimated at hundreds of billions of dollars annually.
  • Indirect expenses such as lost economic productivity from premature death and unnecessary illness exceeds $1 trillion per year.

Statistics barely touch upon the fear involved when any patient thinks about being at the wrong end of a medical mistake. What the patient is all too aware of is the doctor visit that goes by in the blink of an eye. A 2007 analysis of optimal primary-care visits found that they last 16 minutes on average. From 1 to 5 minutes is spent discussing each topic that’s raised. This figure is at the high end of estimates, given that according to other studies, the actual face-to-face time spent with a doctor or other health-care provider comes down to 7 minutes on average. Doctors place the primary blame on increasing de

mands for them to fill out medical reports and detailed insurance claims. Patients tend to believe that doctors want to cram in as many paying customers as they can, or simply that the patient as a person doesn’t matter very much.

 

As a result there’s a new movement afoot to provide a personal advocate who stays in the doctor’s office with the patient. The advocate is basically someone who represents the patient’s best interests in any medical situation. The person might be a well-meaning relative who helps an older patient understand what’s going on, or who steps in to do attendant tasks like picking up prescriptions and organizing medical bills. But more and more one sees the need for an advocate who is professionally trained to buffer the mounting risks in a health-care system in which less and less time is spent between doctor and patient.

It would be up to an advocate to find out, and needless to say, this has created hostility from some doctors. Used to ruling their domain with absolute authority, few doctors want an overseer in the room asking questions, inserting their own opinions, and potentially finding fault. At worst, the specter of a malpractice suit looms. The movement for professional advocates, which is quite young, insists that looking out for a patient’s best interests is benign. The medical profession has its doubts.

The upshot, for now at least, is that patients who want an advocate must play the role themselves. At the heart of the problem is passivity. When we surrender to medical care, whether at the doctor’s office, the ER, or the hospital, we shouldn’t surrender everything. Poking and prodding is intrusive. Undergoing various tests can be stressful. The minute we walk in the door, we become largely anonymous—a walking set of symptoms replaces the person. There are doctors and nurses who take these negative effects seriously and who go out of their way to offer a personal touch. They should be saluted for their humane compassion in a system that focuses more on impersonal efficiency.

You may like your doctor and feel that he cares, but this doesn’t rule out being your own advocate. Quite the opposite—the inherent stress in medical treatment is what you want to counter. First comes the stress of worry and anticipation, what is commonly known as white-coat syndrome. We all remember how afraid we became as children thinking about getting a shot from the school nurse or how scary it was sitting in the dentist’s chair even before the drill was turned on. Studies have verified that anticipating a stressful situation can cause as great a stress response as actually undergoing the stress. In one study subjects were divided into two groups, one of which gave a public speech while the other was told that they were going to give a speech but actually didn’t. Both groups became stressed out, but the researchers wanted to measure how well they recovered from the stress

Knowing that you are going to be in a stressful situation, there are a number of ways to feel more in control:

  • Be informed about your illness. Don’t relinquish your opportunity to find out exactly what is wrong with you. This doesn’t mean you should challenge your doctor. If you feel the need to inform your doctor about something you saw online, you aren’t being confrontational, and most doctors are now used to well-informed patients.
  • If the illness isn’t temporary and minor, contact someone else who is going through the same diagnosis and treatment as you. This may involve a support group, of which many exist online, or simply talking to another patient in the waiting room or hospital.
  • If you are facing a protracted illness, become part of a support group, either locally or online.
  • Keep a journal of your health challenge and the progress you are making toward being healed.
  • Seek emotional support from a friend or confidant who is empathic and who wants to help (in other words, don’t lean upon someone who is merely putting up with you).
  • Establish a personal bond with someone who is part of your care—nurses and physician’s assistants are typically more accessible and have more time than doctors. Ideally, this bond should be based on something the two of you share—family children, hobbies, outside interests—not simply your illness.
  • Resist the temptation to suffer in silence and to go it alone. Isolation brings a false sense of control. What actually works is to maintain a normal life and social contacts as much as possible.

Following these steps will go a long way to achieving the goal of patient advocacy, which is to serve the patient’s best interests at all times. But there remains a difficult unknown, the possibility of a medical error.
 

Seeing the doctor involves personal interaction, and it’s important to reduce any possible friction. Here are a few pointers:

Do

  •             Be involved in your own care.
  •             Inform the doctor and nurses that you like to be involved.
  •             Ask for extra information when you need it.
  •             Ask for a questionable event, like a pill you aren’t sure is the right one, to be checked with the doctor.
  •             Tell somebody if you have gone out of your comfort zone.
  •             Remain polite in all of the above.
  •             Praise the doctor and nurses when it’s called for. A show of gratitude doesn’t go amiss

            Don’t

  •             Don’t act hostile, suspicious, or demanding.
  •             Don’t challenge the competency of doctors and nurses.
  •             Don’t nag or whine, no matter how anxious you are. Reserve these feelings for someone in your family, a friend, or a member of a support group.
  •             Don’t pretend you know as much (or more) than the people who are treating you.
  •             Don’t, when hospitalized, repeatedly press the call button or run to the nurses’ station. Trust their routine. Realize that the main reason patients call a nurse is more out of anxiety than out of real need.
  •             Don’t play the part of a victim. Show your caregivers that you are maintaining a normal sense of security, control, and good cheer even under trying circumstances.

Probably the most important finding about medical mistakes is that they are frequently caused by lack of communication.
In our new book The Healing Self we delve into patient advocacy in more detail as well as covering the expanding role of self-healing, which is going to only become more important in the coming decades.

 

Deepak Chopra MD, FACP, founder of The Chopra Foundation and co-founder of The Chopra Center for Wellbeing, is a world-renowned pioneer in integrative medicine and personal transformation, and is Board Certified in Internal Medicine, Endocrinology and Metabolism.  He is a Fellow of the American College of Physicians and a member of the American Association of Clinical Endocrinologists. Chopra is the author of more than 80 books translated into over 43 languages, including numerous New York Times bestsellers. His latest books are Super Genes co-authored with Rudy Tanzi, Ph.D. and Quantum Healing (Revised and Updated): Exploring the Frontiers of Mind/Body Medicine.  www.deepakchopra.com

 

Rudolph E. Tanzi, Ph.D. is the Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard University and Vice Chair of Neurology at Mass. General Hospital. Dr. Tanzi is the co-author with Deepak Chopra of the New York Times bestseller, Super Brain, and an internationally acclaimed expert on Alzheimer disease. He was included in TIME Magazine’s “TIME 100 Most Influential People in the World.”

 

References:
Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:370–6.

 

Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington DC: National Academy Press, 2000.

 

Department of Health and Human Services. Adverse events in hospitals: national incidence among Medicare beneficiaries. 2010. http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf.

 

A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care James, John T. PhD Journal of Patient Safety: September 2013 – Volume 9 – Issue 3 – p 122–128

doi: 10.1097/PTS.0b013e3182948a69

 

Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ 2016;353:i2139. doi:10.1136/bmj.i2139

 

Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review. Mirelle Hanskamp-SebregtsMarieke ZegersCharles VincentPetra J van GurpHenrica C W de VetHub WollersheimPublished 22 August, 2016 http://bmjopen.bmj.com/content/6/8/e011078.full

 

Weismann JS, Schneider EC, Weingart SN, et al. Comparing patient-reported hospital adverse events with medical records reviews: Do patients know something that hospitals do not? Ann Intern Med. 2008; 149: 100–108.

 

Overview of medical errors and adverse events. Maité Garrouste-Orgeas François Philippart, Cédric BruelAdeline MaxNicolas Lau and B Misset Annals of Intensive Care 20122:2

 

DOI: 10.1186/2110-5820-2-2 Published 16 February 2012

 

Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P: Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009, 338: b814. 10.1136/bmj.b814

 

Ridley SA, Booth SA, Thompson CM: Prescription errors in UK critical care units. Anaesthesia 2004, 59: 1193–1200. 10.1111/j.1365-2044.2004.03969.x

 

Garrouste-Orgeas M, Timsit JF, Vesin A, Schwebel C, Arnodo P, Lefrant JY, Souweine B, Tabah A, Charpentier J, Gontier O, et al.: Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II on behalf of the Outcomerea study group. Am J Respir Crit Care Med 2010, 181: 134–142. 10.1164/rccm.200812-1820OC

 

Garrouste-Orgeas M, Soufir L, Tabah A, Schwebel C, Vesin A, Adrie C, Thuong M, Timsit JF: A multifaceted program for improving quality of care in ICUs (IATROREF STUDY) on behalf of the Outcomerea study group. Critical Care Med, in press.

 

Overview of medical errors and adverse events. Maité Garrouste-Orgeas, François Philippart, Cédric Bruel, Adeline Max, Nicolas Lau and B Misset Annals of Intensive Care20122:2

 

DOI: 10.1186/2110-5820-2-2 Published 16 February 2012

 

Kennerly DA, Kudyakov R, da Graca B, et al. Characterization of adverse events detected in a large health care delivery system using an enhanced Global Trigger Tool over a five-year interval. Health Serv Res 2014;49:1407–25. doi:10.1111/1475-6773.12163 Google Scholar

 

Rutberg H, Borgstedt Risberg M, Sjodahl R, et al. Characterisations of adverse events detected in a university hospital: a 4-year study using the Global Trigger Tool method. BMJ Open 2014;4:e004879. doi:10.1136/bmjopen-2014-004879

 

Christiaans-Dingelhoff I, Smits M, Zwaan L, et al. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports? BMC Health Serv Res 2011;11:49. doi:10.1186/1472-6963-11-49 [CrossRef][Medline]Google Scholar

 

Classen DC, Resar R, Griffin F, et al. ‘Global Trigger Tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood) 2011;30:581–9. doi:10.1377/hlthaff.2011.0190

Sari AB, Sheldon TA, Cracknell A, et al. Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Qual Saf

J Health Care Finance. 2012 Fall;39(1):39-50.

 

The economics of health care quality and medical errors. Andel C1, Davidow SLHollander MMoreno DAhttps://www.ncbi.nlm.nih.gov/pubmed/23155743