Simon, I am a physician. If I am performing a procedure on patient, with which I can cause great harm to that patient if I screw up, you can be sure that just prior to the procedure I am reviewing my dictated notes, lab work and other pertinent data regarding that patient. I guess that comes from training- if as an intern/resident/fellow, I didn't know the patient's complete history, my attending physician/boss would rip me a new one. Relying on one's memory is a roll of the dice- that's why good doctors DOCUMENT, DOCUMENT, DOCUMENT. BTW, the "staff" screws up all the time.
aphrael, in my experience, massive FUBAR's occur when everyone-MD's, nurses, ward clerks, pharmacists, etc.-make mistakes (or are apathetic). My personal, completely ignorant opinion is that medicine is a very late comer to the IT revolution because hospitals had to save pennies instead of investing in IT, and because older MD's are computer phobic (when I was in college taking P-chem, I programmed in FORTRAN...on punch cards!). How much compensation the family deserves is a completely different topic, but it will be settled out of court.
Lydia, I have not had any direct experience with bone marrow transplants BMT since I was a resident doing a 3 week rotation at the Dana-Farber Cancer Institute in Boston (home of the Jimmy Fund, Ted Williams's favorite charity). You probably recall the FUBAR involving the Boston Globe columnist, who had metastatic breast cancer, underwent an autologous BMT, and unintentionally received 5 times the dose of chemo (Cytoxan) needed for the the protocol. It killed all her breast cancer and her heart. One of her Boston Globe colleagues, who has tons of compassions for all sorts of dregs of society, called for severe sanctions (prison?) for those involved.
In regards to solid organ transplants, once a trauma victim is declared brain dead (usually a motorcycle accident, or a gunshot to the head victim), the clock starts ticking. If the family consents to organ donation, the "harvesting" team flies to the hospital, evaluates the donor's suitabilty to donate organs, and draws blood for immediate HLA and ABO typing. This must be done immediately, as a brain dead donor will suffer circulatory collapse in 24 hours, and his/her heart, lungs, kidneys, pancreas and liver will then be unusable. (I have done heart catheterizations on brain dead donors in order to evaluate their suitability for transplant). If the donor has suitable organs, those patients who are awaiting transplant and are a suitable antigen match get paged (they all wear beepers), they rush to their respective hospital, and the harvested organs get flown by private jet for transplant.. It is an emergency, and it is well documented that more FUBAR's occur during emergencies. I don't know how the surgeon at Duke screwed-up, whether he just overlooked it, or if he assumed someone else checked it. Let me tell you though, there are plenty of people in medicine/hospitals whose attitude is "it's not my problem" (Some fucker just told that today) and they deserve a kick in the crotch, or a pink slip..
In regards to a surgeon amputating the wrong foot, there is absolutely no excuse for a surgeon not to see and examine a patient prior to surgery. Being overworked is not a valid excuse either. First of all, not to do so is sanctionableby the hospital and medical boards. Second, the family and the patient are greatly comforted by talking with the person performing the invasive procedure, and studies show even if you have a bad outcome, if you talk to and comfort the patient/family, they are far less likely to sue you. Nonetheless, bad doctors and bad hospitals attract each other. I have been called to do emergency cardiology consults on post-op patient (who are asleep), and found that neither the surgeon, nor the anesthesiologist have written or dictated a preop or postop note. Good hospitals don't let crap like that happen (and it is a JCAHO violation); bad hospitals need the business, even from crappy doctors.
Kevin Maroney, I would love to see the bottom 5% of physicians, who apparently are responsible for 66% of malpractice claims, lose their license. Wouldn't it be nice if the bottom 5% of all profession were forced to find different jobs?
Finally, if you want to avoid heart disease, don't be a couch potato, get exercise, don't let yourself become obese, don't smoke cigarettes, eat vegetables and fruits with plenty of anti-oxidants (Vitamine E, C, and beta- carotene do NOT work) and have a glass or 2 of red wine a day. Oh, and use olive oil with your bread, not margarine or butter.
Now that I have vented those evil humors...
Lydia, in response to your question, those involved in solid organ transplants are presumably in a "use it or lose it" situation. With bone marrow transplants, I believe HLA matching is far more important than ABO compatibility for a successful transplant, and as you mentioned one has the luxury of a little time. Nonetheless, what happened at Duke was a massive clusterf--k, and a career ending debacle for the surgeon involved. My feeling is "there but for the grace of God..." In regards to surgeons who amputate the wrong leg, bad hospitals have bad doctors because they can't attract good doctors, and bad doctors go to bad hospitals because good hospitals find ways to run them out.
Kevin Maroney, a patient of mine had a large myocardial infarction. I later found out his primary care physician (the "gatekeeper") told him his chest pains prior to his heart attack were chest wall pains and prescribed ibuprofen. I was so pissed off by this (afterall, I was the one in at 2AM, doing his emergency coronary stent, while the other doctor was asleep at home), I told him to talk to some lawyers, but noone would take his case.
And Brad Delong, I recall it was Tip O'Neill who first mentioned "Errors and No-facts" in his book "Man of the House." I can't believe you credited Viagra boy with that. What are you, a closet wing-nut? (I actually very much enjoy your work).
As I have read the comment sections of several blogs regarding this case, I am just amazed at the sheer perfection of non- physicians, who clearly have never made a mistake in their lives. Myself, I'm one of those greedy, uncaring doctors who only cares about my Mercedes and my golf game. I scammed my way through college and managed to graduate 0.17 GPA points short of a perfect 4.0. I even cheated my way into med school by graduating at the age of 20. When I'm on call for emergencies, I'm such a slime ball, I even try to get a few hours of sleep at night.. Even though I'm such a scumbucket of a human being, my failure rate is not as bad as airport security screeners, or space shuttle missions. Life must be great when your feces has no unpleasant aromas.
What gives all of you the right the right to demand perfection in medicine, where no one- doctors, nurses, orderlies, ward secretaries, etc.,- ever makes mistakes, when you have allowed medicine to be cut to the bare bones? (if that's not true, explain the severe nursing shortage everywhere). And spare me the crap about doctors protecting other doctors; first, no one would appreciate it more to see incompetent MD's stripped of their licences than me. Second, in order to strip a physician of medical privledges, medical incompetence, which is notoriously hard to prove, must be be meticulously documented; otherwise, the MD in question has numerous LEGAL recourse to countersue. Finally, state medical boards ARE a public institution, and would respond to a public outcry about bad doctors and hospitals, if the public were so motivated.
| Year | Number of comments posted |
|---|---|
| 2003 | 5 |
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