Improving medical students

Archive for the ‘Medical Errors’ Category

TV’s Interference in Medical Education

Posted by medliorator on April 5, 2009

Tom Blackwell:

Intubation is the insertion of a tube down the windpipe, usually so a patient can be hooked up to a mechanical ventilator when they are unable to breathe properly on their own.

The first step is to position the head properly so the tube can be quickly and easily installed.

Dr. Brindley said he and his colleague, Dr. Craig Needham, noticed that many students and residents – medical-school graduates training in specialities such as anesthesia, surgery and emergency care – positioned the head incorrectly.

To find out where the faulty knowledge was coming from, the physicians surveyed 80 students and residents. Many said they learned through “trial and error,” but a large proportion indicated they had picked up tips from white-coated TV characters.

ER was the program most commonly cited by the students, so Drs. Brindley and Needham analyzed a season of the show. Some aspect of the head positioning was wrong in all 22 intubations that could be fully viewed on screen, their paper says.

Young doctors learn bad habits from TV medical dramas [National Post]

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Managing the Stress of a Medical Career – Talking to Eachother

Posted by medliorator on January 28, 2009

George Hossfeld, MD, assistant professor of emergency medicine at the University of Illinois-Chicago, on is medical malpractice experience:

It felt very personal when they asked for an award far more than my policy limits, and I, as the sole defendant, had to imagine the possibility of losing my house, retirement savings, and kids’ college fund. Through a stroke of luck, the jury returned a decision for the defense. No one will convince me that on another day, a different group of 12 people could not have found me guilty, and awarded my future to the plaintiff.

There is no way the term winner can be applied to me. With luck, survivor is all I hope to realize.

Physicians do not advertise the fact that they are being or have been sued because they know that it is a slur on one’s reputation. The secrecy with which we treat the issue serves to underscore that point.

Silence contradicts all we know about stress management. Stress causes anxiety, isolation, and helplessness, and has led some to suicide. Enlightenment through exposure would go a long way in removing the stigma associated with its very name.

The public has been told that malpractice occurs to those few bad doctors, and that the rest of us have no experience with it. It’s hard for them to have much sympathy when that’s the case. What an epiphany it will be to find that their doctor, in fact, all of their doctors have experience with being sued! Now that’s a horse of a different color! Exposure will lighten the shame, disgrace, and dishonor that we have falsely granted it. Exposure may create a groundswell of disgusted colleagues who are going to demand change.

Speak the Unspeakable: ‘I Was Sued for Malpractice’ [Emergency Medicine News:Volume 31(1)January 2009p 3, 16]

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How to Correct Medical Errors

Posted by medliorator on December 2, 2008

Megan Fix, MD:

When medical errors occur, it is our duty to disclose them. Truthful disclosure is good for patients. Recent evidence shows us that most patients actually prefer to know about medical errors that have happened to them. Furthermore, surveyed patients said they would be less likely to sue if they were informed of the error by the attending physician.

The easiest way is to be direct and honest in a respectful manner. You are never wrong if you put the patient first. Remember that you are a part of a team.

Get the facts
It never hurts to say something like, “this may be a ridiculous question but…” or “I may be mistaken, but…” This is a respectful way to ask what is right for the patient and oftentimes, once the error is identified, both you and the attending physician can then respond and inform the patient together.

You may feel compelled to “tell” on the attending physician or resident who committed the error, but this will not only undermine your relationship with the patient, it will also create distrust and lack of confidence within the whole medical team… One way is to respect the authority of the attending physician by asking for their assistance. This can help deflect possible defensiveness that may arise. For example, you might say, “I spoke with Mrs. Jones and she is very concerned about X. I would like your help discussing it with her.” If that does not work, then approach your resident. Again, put the patient first as in, “I was concerned about our patient when I saw Y. I’d like to talk to the attending physician, will you join me?”

What Should I Do If I Witness a Medical Error? [Medscape]

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How do Doctors Heal?

Posted by medliorator on September 7, 2008

One of my friends lost a patient some time ago… It was the kind of case every anesthesiologist hopes never to have to face.  Unfortunately, it’s also the kind of situation that comes to every anesthesiologist’s table sooner or later, regardless of his or her skill and experience. My anesthesiologist friend asked me a very thought-provoking question after he told me about his experience… “Are you willing to continue in a career knowing that this will happen to you someday, if it hasn’t already, and you’re going to have to deal with it and live with it and not give in to grief and self-doubt afterward? Do you love this work and believe in yourself enough to keep going? Because if you don’t, you need to get out now while you can.”

Doctors grieve. Doctors shed tears, seen and unseen, over patients, for many different reasons – at least, the ones who care do. I know this to be true. Seen it. Done it. But doctors also can’t be debilitated by grief or doubt or regret for too long. Other lives hang in the balance. The question is, how do doctors heal?

Losing Patients [Notes of an Anesthesioboist]

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How to Avoid Clinical Errors

Posted by medliorator on May 30, 2008

Ted R. Melnick, MD…

1. A common disease presenting in a common way (horses);
2. A common disease presenting in an uncommon way;
3. An uncommon disease presenting in a common way; and
4. An uncommon disease presenting in an uncommon way (zebras).

After seeing horse after horse, we develop pattern recognition and must be careful not to automatically identify every case as a horse, potentially failing to recognize a true zebra.

Attending a QA or PI meeting or an M&M conference is a great way to get exposure to how physicians approach their mistakes and what they do to prevent them in the future.

How Can I Avoid Clinical Mistakes? [Medscape]

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Medical Errors

Posted by medliorator on June 4, 2007

Every attending has at least one or two areas where they have previously “gotten burned.” No matter how hard we try to be perfect, we will represent, and later resent, our humanity, our imperfection. We will do something that will greatly harm a patient. I’m sadly starting to learn something that may explain doctor behavior: trust nothing.


an intoxicated gentleman comes in, found down, complaining of generalized body weakness for which he has been seen on numerous occasions. Nurses know him by first name, and note that this is his typical course – he comes in, sobers up, leaves. Being astute medical student that I am, I want to rule out Other Badness. Sugar normal, exam normal. I draw labs. Just ’cause. Much later my attending decides we should also get an EKG. Just as it’s printing out and I’m noting the U waves and the long QT, the lab calls with his low potassium and calcium results. Ugh. Had I just decided to get the EKG to begin with, we could’ve caught this much quicker. But I decided, “No, he comes in like this all the time, the nurses see him like this all the time, he’s probably just drunk.” Now, nothing bad happened to the gentleman–we fixed him right up–but I can just barely see other versions of the story, and it’s scary.

Getting Burned [Over My Med Body]

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