#medical error

[teachingrounds]

Despite the furor c.2010 about a possible "July effect" when new interns arrive, it seems that for every article that finds major or minor differences between patient outcomes (length of stay, rate of errors, cost of hospital bill, complications, unexpected death), there is another that finds no difference.

For instance, a 2017 study of Family Medicine admissions found small increases in mortality among patients admitted with myocardial infarction in the first academic quarter of 2011 (July-September) compared with all other quarters in teaching versus nonteaching hospitals, but only increased cost and longer stay for those admitted with heart failure.

However, a larger study using data from 2010 to 2017 found no difference in adverse events in July/August compared to the rest of year once results were adjusted for patient and hospital characteristics; they looked at a range of surgical and non-surgical (MI, PNA, heart failure) diagnoses at major teaching hospitals, minor teaching hospitals, and non-teaching hospitals across. They concluded, "Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months."

Mims LD, Porter M, Simpson KN, Carek PJ. The "July Effect": A Look at July Medical Admissions in Teaching Hospitals. J Am Board Fam Med. 2017;30(2):189-195. doi:10.3122/jabfm.2017.02.160214

Metersky ML, Eldridge N, Wang Y, et al. Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?. J Patient Saf. 2022;18(3):253-259. doi:10.1097/PTS.0000000000000887

Image credit: Seattle Municipal Archives, Doctors with patient 1999, Flickr

[lifewithaview]

Sela Ward and Hugh Laurie in House (2004) The Mistake

S2E8

Chaos ensues after Chase's negligence leads to the death of a female patient. Now, after an inquiry from the hospital board, and a subpoena from the patient's brother, it's up to Stacey to protect Chase's career, as well as House's.

*At the beginning of the episode, Kayla's daughters tell her that Sally Ayersman has been teasing them, to which Kayla responds, "If Sally's mean to you again, I'm just gonna have to key her daddy's new convertible." However, later in the episode, House blackmails a surgeon into doing Kayla's liver transplant. The surgeon is a Dr. Ayersman, whose wife, getting an "anonymous" tip about her husband's cheating, decides to key his new convertible. In House's words, "Enough irony for us all."

[shelbywanders]

*** Trigger warnings ***

Medical procedure gone wrong / Traumatic birth / Chronic illness

Please read chapter 1 before reading 💜

Chapter 2 - New Mom Stress

I’m adjusting to life as a new mama. Having a newborn is challenging, you’re up all day and night, you’ve suddenly become another humans life line. You can read all the books, all the blogs, take all the classes you want to prepare for having a newborn, but trust me, you will not feel prepared even with that all. It’s a huge adjustment! It’s amazing, it’s incredible the amount of love you have for something so tiny but it’s hard and overwhelming too.

It’s also hard doing it all when you’re in a lot of pain. No matter what kind of pain, taking care of someone else when you can hardly handle yourself is hard. But my pain, was my head. For 10 days straight after the epidural incident when I gave birth, I had the most painful headache I’ve ever experienced. It wasn’t a normal headache, it was that same excruciating head pressure pain I got during whatever happened with the epidural. Nothing helped it. I was taking prescribed ibuprofen (I had just gave birth, remember!) and Tylenol and it didn’t phase the head pain at all. I remember it got so bad the only thing I could do was cry. And crying makes headaches worse so if someone is crying with a headache, you know it fucking hurts. I was also a new mom, I was learning how to breastfeed, I was learning how to take care of a baby, I was sleep deprived. And I had a giant wound in my vagina from pushing a whole human out. Basically, a lot of things were happening that was new to my body, so I assumed the headache was nothing more than my body trying to adjust.

But almost two weeks had passed and I just couldn’t take it anymore, so I called my OB and explained how this headache hasn’t gone away since getting the epidural and I was just worried. We made an appointment and I went in, she was concerned of my blood pressure being high or possibly developing post-eclampsia. But everything was okay. I got the whole spiel of “you’re a new mom, you’re breastfeeding, your hormones are all whacky. It will probably go away soon,” and was sent home. Which of course at the time, made sense to me. Although I still had the feeling that something wasn’t right, the pain I experienced during my epidural wasn’t normal and now this headache was debilitating. But I was a new mom. And the doctor said I was fine. Who was I to question anybody?

I kept going, because I had to. It had to get better at some point? The head pain did stop being constant…but it never went fully away. I started to notice a pattern with the head pain, and it was way worse when I did certain things. I noticed that if I bent over, I would get the headache. If I coughed/sneezed/strained in any way, here comes the headache. If I moved my head too fast, headache. If I stood up too fast, headache. Any change of pressure…my head felt like it was going to explode just like it did during the epidural incident. I lived with it for 4 months just thinking it will get better, the doctor said it was stress, it’ll get better. But it never did. It was getting too much to handle, I can’t even bend over to pick up my 10 lb baby, something is seriously not right…So I started the search for a neurologist, to get the first of many opinions.

Stay tuned for chapter 3.

*DISCLAIMER*

This is blog is not intended for medical advice nor intended to diagnose, treat, cure or prevent any disease. This blog is based off of personal experience.

[doc-resilient]

on physicians & mental health: a resident’s fake wellness curriculum

Physician wellness and mental health, particularly in medical education, is not a topic I thought I would be passionate about but somehow during my training, it happened. (Long story.) 

May is Mental Health Awareness Month. In honor of this month, I would like to post some content covering topics affecting physicians’ mental health and the health system.

All discussion and more content shares welcome!

1.  MEDICAL ERROR AND TALKING ABOUT IT Y’ALL

TedX: Doctors make mistakes. Can we talk about that? (Time: 20 min)

[wayfaringmd]

Hello! I was wondering if I could ask you, how would you talk to a patient after a medical error?

Good question!

The general rule is to acknowledge that an error was made, apologize for it if necessary, and then work on making sure the same mistake doesn’t happen again.

In actual practice, it really depends on the error. 

An order placed on the wrong chart that was caught and fixed before it was carried out? Fine. Probably doesn’t need to be divulged to the patient because it just increases patient anxiety and mistrust. These mistakes often still get reported within the hospital to a review board or risk management committee to help prevent future errors (and ultimately, patient harm and lawsuits). At my hospital, that would be reported as a near miss and staff would be educated or a new chart identification system would be put in place to prevent that error from happening in the future. 

What if a patient gets an incorrect drug or dose but no harm is done? That’s sort of up to the discretion of the doctor but in general it’s still a good idea to own up to it. But say an order was placed on the wrong chart and a patient ended up getting a medication that they were allergic to or that made their problem worse or that caused some new problem. That’s absolutely something that should be discussed with the patient. 

It should be noted that many states now have laws in place that allow for doctors to explain and apologize for medical errors without fear of their words being used to sue them. 

I would approach the situation by first asking about the patient’s wellbeing. Show them you care about what’s happening to them more than covering your butt. Then I would explain what was intended to happen vs. what actually happened and SAY THE ACTUAL WORDS “I’m sorry.” I personally think as a doctor it’s important not to place blame on an individual who is carrying out my orders (unless they blatantly went against those orders) if they made a mistake.  However, it might be appropriate to have the person who made the error apologize too. I think it would be good to pause and allow the patient to absorb what happened and even get mad or complain afterward. And after that, lay out to the patient how you are going to make things right. What’s the next treatment plan? What are you / your office / your hospital going to do to prevent a recurrence of this error? 

In the end, the patient may still be harmed and your apology may not fix things, but it does show that you care about the patient and are trustworthy. Plus apologizing before the patient even knows an error has happened helps prevent more confusion and misplaced anger and conflict. They may still fire you or sue you, but at least your conscience can be clean. 

[teachingrounds]

The "July effect" is the idea that medical errors spike in the United States in the month of July because that's when new interns start practicing medicine and the second-year residents start supervising for the first time. The concept comes from a 2010 study published in the Journal of General Internal Medicine by a pair of sociologists interested in studying mortality. Looking at all 62+ million US death certificates from 1797 to 2006, they found that there was a 10% increase in fatal medication errors in teaching hospitals in July and nowhere else at any time. Supposedly there was no spike in other causes of death by medical error (e.g. in surgery, from infection, misdiagnosis, etc.). The authors attributed this to new residents practicing with insufficient oversight by attendings, pharmacists, or nurses. We'll spend the rest of the week looking at the evidence for--or against--a "July effect."

Phillips DP, Barker GE. A July spike in fatal medication errors: a possible effect of new medical residents. J Gen Intern Med. 2010;25(8):774-779. doi:10.1007/s11606-010-1356-3

Image: Parentingupstream, Pixabay (2016)

[kazifatagar]

New: Woman, 63, dies after Singapore doctor cuts wrong blood vessels during kidney surgery

SINGAPORE – A coroner’s inquiry has revealed shocking details of a botched kidney surgery at Raffles Hospital that may have contributed to a 63-year-old patient’s death in 2022. Urologist Fong Yan Kit mistakenly cut the wrong blood vessels while removing a tumour and failed to take timely remedial steps, such as calling a vascular surgeon. wrong blood vessels The patient later suffered organ…

New: Woman, 63, dies after Singapore doctor cuts wrong blood vessels during kidney surgery

[haridiva]

Antara Keadilan dan Ketakutan: Dilema Kriminalisasi Malpraktik dalam Sistem Kesehatan Indonesia

Seorang dokter spesialis bedah di rumah sakit kabupaten menerima pasien kecelakaan lalu lintas dengan perdarahan internal masif pada dini hari. Tidak ada dokter anestesi yang bertugas. Peralatan monitoring terbatas. Persediaan darah menipis. Ia harus memilih: mengoperasi dengan risiko tinggi atau merujuk ke kota dengan kemungkinan pasien tidak sampai hidup. Ia memutuskan operasi. Pasien meninggal…

Antara Keadilan dan Ketakutan: Dilema Kriminalisasi Malpraktik dalam Sistem Kesehatan Indonesia