tag:blogger.com,1999:blog-4968787219619380438.post2474707091332006672..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: A simple mistake?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-4968787219619380438.post-33003706482608003132013-02-15T11:29:17.848-05:002013-02-15T11:29:17.848-05:00Sorry. It sounds like you suffered a lot. I hope y...Sorry. It sounds like you suffered a lot. I hope you are feeling better now.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-21793887481930017452013-02-14T13:58:49.794-05:002013-02-14T13:58:49.794-05:00I went into an ER with a temp,high blood pressure,...I went into an ER with a temp,high blood pressure, hr,and I was complaining of the red spots in my groin, pain in my legs,inflammation that was spreading. I knew I had a spreading infection and asked for antibiotics to clear things up but I was refused the antibiotics. The ER doctor had listed what I had as"Probably Viral". Then I see purple spots by my chest and left armpit..Well by ER visits 4 I also have Meningitis..It traveled up my spine into my head I can feel my brain swelling in my head as a response to the burning going from the right side, back of my head, left side and then the top..What happens next is the kind of thing that most people would not want to believe..An extensive cover up ensued with a doctor getting me out of the ER immediately after the spinal tap and also a CT of my head confirmed the site of infection. I become drowsy and cannot feel my limbs when I am brought home and then returned back to an ER after the spinal tap and I am denied medical help..The condition I am left in made to look like a psychiatric problem..The rest of what happened is horrific. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-52689391444827315292012-10-05T08:46:39.466-04:002012-10-05T08:46:39.466-04:00I found your website the other day and after readi...I found your website the other day and after reading a handful of posts, thought I would say thank you for all the great content. Keep it coming! I will try to stop by here more often.Skin & Laser Centerhttps://twitter.com/#!/drbajoghli/noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-16366868592709547272012-08-14T14:11:27.456-04:002012-08-14T14:11:27.456-04:00I agree that the EMR may be a factor. But one of t...I agree that the EMR may be a factor. But one of the articles about this incident mentioned the printing of the lab results. This suggests that maybe the NYU Medical Center is not up to speed with their EMR. Some EMRs flag all unread lab results, which is quite helpful unless the doctor ignores the flags.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-80391386672881319762012-08-13T11:21:20.020-04:002012-08-13T11:21:20.020-04:00This an example of the failure to assure that elec...This an example of the failure to assure that electronic medical records devices' silos are not silent when new results arrive. The default is to blame users, but, the workflow is terribly disrupted as a result of EMR devices' design flaws, rendering even the most competent doctors and nurses error prone.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-22468056491976592902012-07-29T19:19:54.757-04:002012-07-29T19:19:54.757-04:00Anon, I'm with you. The HIPAA law was over the...Anon, I'm with you. The HIPAA law was over the top. It is one of the most misunderstood and annoying laws ever passed.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-38171924398830329872012-07-29T08:09:40.421-04:002012-07-29T08:09:40.421-04:00Hipaa now prevents you from accessing yor own reco...Hipaa now prevents you from accessing yor own record in that manner. With MU you can get it... But there's an administrative window. Would not have assisted you much to have seen your results 48, 72, hours or even days later now would it?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-12453796727959121642012-07-26T20:57:57.352-04:002012-07-26T20:57:57.352-04:00The onus is always on the physician. People have t...The onus is always on the physician. People have tried to create algorithms for things like this. Medicine is a little too complex so far. Maybe some day.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-7520397870371921212012-07-26T08:20:35.430-04:002012-07-26T08:20:35.430-04:00About Dr. Scarbrough's case, I think at some p...About Dr. Scarbrough's case, I think at some places attending reads are done in the morning, so perhaps the usual rigors weren't applied by then. I agree docs should recheck their reads, I've seen things missed a thousand times. With the sheer volume of reads that the radiologists have to do, I'm sure a few out of the thousands may slip through no matter how careful someone is. <br /><br />I wonder if there is a better way around it. For instance, are there computer systems that can detect and stratify reads according to suspicion? Perhaps out of naiveté, I imagine a hospital 20 years from now with an integrated EMR that can communicate intake vitals and labs to such a computer to create a clinical rating just like this. But as my girlfriend (who is a lawyer) points out, if somethings goes wrong, then who would get sued? The onus still may still end up on the physician.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85391526678556100282012-07-25T18:26:45.412-04:002012-07-25T18:26:45.412-04:00Wow, Dr. Scarbrough, that is truly something else....Wow, Dr. Scarbrough, that is truly something else.K_Chiehttps://www.blogger.com/profile/06578964502443236227noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-61056409870254186842012-07-25T18:24:31.970-04:002012-07-25T18:24:31.970-04:00Dr. Scalpel, I agree with you. Too many system err...Dr. Scalpel, I agree with you. Too many system errors. Others that I explored in my own blog. It truly is a shame.K_Chiehttps://www.blogger.com/profile/06578964502443236227noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-22695416053212935322012-07-25T17:22:12.034-04:002012-07-25T17:22:12.034-04:00Carolyn, I agree with you, especially your last pa...Carolyn, I agree with you, especially your last paragraph. I wish more med schools would teach problem-solving. I've blogged about this before.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-37279508780454221442012-07-25T17:08:18.905-04:002012-07-25T17:08:18.905-04:00Dr. Scalpel - your observations do indeed seem to ...Dr. Scalpel - your observations do indeed seem to confirm that this sad outcome was not merely the result of a simple mistake. <br /><br />Rather, if things indeed unfolded as you indicate here, the outcome looks like the inevitable result of MANY simple mistakes, one after another after another, from miscommunication to poor hand-off protocol, misdiagnosis of troubling symptoms that were clearly not flu-related (inability to walk, etc), a 3-hour delay in lab results, and on and on.<br /><br />Throw in the E.R.'s "throughput" pressures and you have a perfect storm of catastrophic proportions.<br /><br />I suspect your doctor friend from another hospital may indeed have been closest to the truth: the diagnostic issue of confirmation bias and other forms of "thinking errors" are well-documented. I've read that some med schools are in fact now beginning to teach something called "metacognition" = a reflective approach to problem-solving that involves stepping back from the immediate problem to examine and reflect on the thinking process.Carolyn Thomashttp://myheartsisters.org/2011/05/09/misdiagnosed-heart-attack/noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60998590866350629472012-07-25T16:17:15.874-04:002012-07-25T16:17:15.874-04:00Robert, I agree with you comment. Thanks.
Todd, t...Robert, I agree with you comment. Thanks.<br /><br />Todd, that is some story. You were fortunate to have been able to help yourself. I think ED MDs should look at films they order. Your case is proof that radiologists do make mistakes. But shouldn't the resident's reading have been checked by an attending radiologist?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-8475805089579010562012-07-25T13:38:04.531-04:002012-07-25T13:38:04.531-04:00In ~2000, at the age of 28, I got a kidney stone. ...In ~2000, at the age of 28, I got a kidney stone. I was a radiation oncology resident at the time. In March of 2001, still a resident, I felt the familiar pain and problems again. I traveled 200 miles from my parents' (I was on vacation) to go back to my home institution to get cared for there (I knew the docs and I had extreme faith in their expertise).<br /><br />On a Sunday night, I showed up in the academic institution ER in a classic kidney stone sort of presentation. I was given fluids, pain meds, and discharged home. I spent all Monday feeling miserable. Not knowing what else to do, I went back the ER that Monday night. Labs were drawn, fluids were given, I had a CT abdomen done this time, and I was discharged home. Tuesday... I felt rotten. It felt like my whole right side of my body was heavy. I just felt "sick." I *again* went back to the ER, seeing the same ER doctor, given fluids, pain meds, and sent home. Tuesday night, at midnight, feeling horrible still... I logged in to the hospital system from home (I was a resident, I had access obviously). I was being told everything was normal and I just had to wait for the stone to pass.<br /><br />As I checked my labs, my 'lytes were pretty screwy and I had a white count of about 18K, neutrophils very high too. "Wow" I thought. "I'm pretty sick and feel it--wonder if I should take antibiotics?" No one mentioned my abnormal labs to me. So then I thought--I wonder what my CT showed. So I pulled up my films. I had a HUGE right kidney! It was pretty significant hydropnephrosis and hydroureter (my ureter was as a thick as a ballpark frank on that side). I was told in the ER that my CT was "normal." "Hmmm... kind of septic... blown up kidney... I should call the ER doc."<br /><br />So I got the ER doc on the phone. "Hey, regarding my normal labs and normal CT: I have a big hydronephrosis on the right, and my white count is pretty elevated. Can you look at my CT scans again?"<br /><br />Long story short, I was taken to the OR first thing Wednesday AM for laser lithotripsy. The ER doc later told me that the resident reading CTs that night had told him my CT was normal; the ER doc himself had not looked at the films (nor would I necessarily expect him to).<br /><br />So in medicine there are oft times no "simple mistakes." Even the simplest require a complex series of errors to occur sometimes. Self-advocacy and family advocacy is invaluable too. I don't know how things would've turned out if I hadn't had the capability to see my own labs and scans and understand them--AND offer corrective guidance to my caregivers.Todd J. Scarbrough, M.D.https://www.blogger.com/profile/09254631173069503684noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9037457926883398142012-07-25T10:55:38.206-04:002012-07-25T10:55:38.206-04:00In addition to the 'multiple holes in the chee...In addition to the 'multiple holes in the cheese' that you mention, maybe one of the holes is the failure of the pediatrician to do her job. Surely she knew this patient better than the ED docs and was hopefully FAR more likely to see the seriousness of the problem. If she didn't see the patient, she should have. If she did see the patient, she should have been more aggressive in following up, knowing that he was clearly not well. As you have mentioned before, the hand-off is a dangerous time. Just ask any quarterback. And I hate to mention 'incentives'(aka financial issues), but I will anyway; if she were penalized by her ACO for sending one of her patients to the ED during office hours, would this still have happened? Probably not.RobertL39noreply@blogger.com