For almost twenty years I have focused on the quality and safety of healthcare. During that time I’ve seen my colleagues recognize and address  the gaps in best practices that perpetuate clinical errors. There have been remarkable advances in the past five years alone. Yet it is clear that we are still at the beginning of a long journey.

I’ve always believed that hospital safety requires an engaged and empowered patient or patient advocate. When people get sick, naturally they are scared and anxious. Because of this, patients are often afraid to speak up in the authoritarian environment of many medical centers. Sometimes patients don’t even know their caregivers’ names, which contributes to their reluctance to ask questions. Even physicians when they themselves are hospital patients can be passive, afraid they will be criticized for being outspoken or difficult.

Looking back upon dozens of medical errors, I see it is all too common for patients or family members to remain silent when they suspect something is wrong or improper in their care.

One example I will never forget involved a middle-aged woman who underwent an extensive battery of tests and procedures meant for another patient. After several hours of testing, an astute technician discovered the hospital had been testing the wrong patient. Fortunately, no harm was done. We learned that personnel in the admissions office had placed another patient’s ID bracelet on this woman. When we asked the patient why she had responded when called by the wrong name, she replied that she thought the hospital must know what it was doing. She assumed she was being called by the name of the doctor who would be taking care of her. This seemed odd, she said, but she didn’t want to offend hospital personnel.

In this book, I’ve tried to look at the hospital from your perspective. I’ve used my experience as a physician, administrator and researcher in quality and safety to ask the questions for you, the patient. I’ve asked the leaders in clinical thought to put themselves in your shoes and help you become an active partner in your care.

Engaged and questioning patients can be more difficult for doctors, nurses, and hospital staff to care for. But enlightened medical professionals recognize that patients need to be partners in their own care. I hope this book will encourage you to ask questions, share concerns, make suggestions and become an active member of your healthcare team. I believe it is only when you and your family are full participants that we can have the safest hospital possible.

                                                                        David J. Shulkin, M.D.