For all the medical malpractice that is out there and all the different ways a health care provider can screw up, I still see many of the same things over and over. In light of how common some of these occurrences are, you would think the doctors and hospitals would do a better job of stopping them. On the other hand, since many of them are rooted in the foibles of human nature, they are going to be exceptionally resistant to change.
Communication Errors: Think of the old game of Telephone. As the message is passed from person to person, it changes to the point that it may no longer be recognizable. Medical communication is not that bad, but it is a very frequent cause of medical mistakes.
We are imperfect creatures. Many of us are naturally impatient. Under the best of circumstances, we don’t communicate clearly. We may not give enough information. We may assume that the person we are speaking to or messaging knows more than they do. We may make a mistake in what we say.
Suffice it to say that for whatever reason, communications issues are a part of many malpractice situations. Many times the conversation or message was not recorded and there is a “He said, she said” disagreement over who said what to whom. While that kind of dispute may be good for the subsequent lawsuit, it is never good for the patient at the time.
Unconscious Bias Problems: I see this often in cases of misdiagnosis, which is one of the most common forms of medical malpractice. Doctors or other providers see what they expect to see. They disregard symptoms or complaints that do not match the diagnosis they already have in mind. They stop listening to patients after they have heard just enough to convince them about the diagnosis, which, of course, is incorrect and does not match all of the information they were given and disregarded.
Unconscious bias is a particular problem for women with chest pain. Doctors are used to men with chest pain being possible heart attack patients and always at least think of that, even if they sometimes mistakenly rule it out. Not so much with women reporting the same chest pain. Women with chest pain due to a heart attack are much more likely to be diagnosed with some other malady and often to their great detriment. After all, everyone knows that women don’t get heart disease like men.
I have also seen unconscious bias with some regularity in post-operative complications in the hospital. Nurses caring for the patient, usually at night, see changes in the condition of the patient, but convince themselves that the changes are minor or harmless. Sometimes the nurses are so sure there is nothing going on that they directly disobey an order from the doctor to call in the event of the very change they are witnessing.
Failure to Follow Up: Sometimes things start out really well. The doctor listens, the doctor considers all of the evidence, and the doctor reaches a differential diagnosis that includes the correct medical condition. All that needs to be done now is some testing to decide which of the conditions on the differential diagnosis list it is. Sadly, not all of the testing gets done. In one case in which I represented the widow and children, three of the four planned tests were performed. The one which would have revealed the life-threatening heart condition was missed somehow, even though it was mentioned in the medical chart as one of the tests that had to be done. Months went by with no one noticing the missing test. You know what happened next. Failure to do all of the necessary testing is a fairly common problem that sometimes leads to tragic consequences.
Failure to Pay Attention: This is a particularly hard one to understand. A test is ordered and is properly performed. The result reveals an emergency situation. The lab calls the ordering doctor or the ordering doctor’s office and reports the emergency result. After that, nothing. No one does anything in response and the emergency gets out of control to the great detriment of the poor patient, who never learns of the emergency until it is too late.
Human nature is a stubborn thing. It is not going to change. We can rage against it and try to think of ways to make sure doctors and nurses do the right thing, but at best we will only be able to reduce the damage it does.
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