Tag: Medical Malpractice

Although the analogy to a food item might not seem immediately intuitive regarding medical error, it actually does make sense with just a brief bit of explanation.

A doctor who has long been concerned with the lingering — and, demonstrably, outsized — problem of medical misdiagnosis says that it is an element of medical error that is particularly hard to get a handle on and deal with, especially when compared to other types of medical mistakes.

Like medication errors, for instance, the source of which can often be discovered through a methodical look back at the chronology of what transpired during a patient’s visit and treatment.

“You can trace the steps and line up the holes in the Swiss cheese,” the doctor says. And in doing so, you can detect where error occurred.

Arguably, that is not as easily done where diagnostic error — a missed, delayed or flatly wrong diagnosis — is concerned. As noted in an article on that subject, cognitive-related factors are often at the heart of misdiagnosis, and they can be hard to detect.

Put another way: Diagnostic mistakes often owe to physicians’ doubts, biases, assumptions and predilections to think a certain way.

The aforementioned article mentions a number of cognitive causes that can fuel misdiagnosis. Anchoring, for example, is “locking in on diagnoses based on initial symptoms” without engaging in further analysis. Diagnosis momentum can result in wrong conclusions based on what other doctors have erroneously concluded.

An Institute of Medicine report on misdiagnosis is scheduled to be released next month. As the above article notes, many medical industry commentators believe that the IOM’s analysis and findings “will finally give the problem its due.”

The non-profit and independent organization that accredits thousands of medical facilities across the United States has expressed a concern with a common post-surgical complication called respiratory distress.

The Joint Commission’s focus upon RD is both logical and timely, given the often outsized and dire consequences that result for patients who experience this serious complication.

The chief symptom associated with RD, and one which is directly implied by its name, is breathing difficulty — often so extreme that it can result in truly catastrophic outcomes, including death.

As a recent media article discussing RD notes, the malady is especially linked to a relatively brief period following completion of a surgery, when a patient can be highly vulnerable and taking powerful pain-killing drugs.

Such drugs — particularly opioid-based medicines, can be catalysts that produce depressed breathing.

And their effect can be severe when, as pointed out in the above-cited article, more than one doctor is prescribing medications to a post-surgical patient.

That problem can be a huge concern, notes a recent study of RD, with researchers pointing to multiple sources of med prescribing being common in malpractice cases alleging respiratory depression.

Taking away those multiple prescribing sources and implementing strong RD identification and monitoring tools can drive down respiratory depression-related incidents to a negligible degree, say study authors.

Coordinating med prescribing following surgery is absolutely essential, say researchers, who note that more than one-third of the malpractice actions they scrutinized featured multiple physicians prescribing opioid-based drugs.

So, too, they note, is enhanced training for nurses who work closely with post-operative patients who might reasonably be at risk of a respiratory depression episode.

So, you are admitted to a hospital in Southern California for a surgical procedure. Your operation is a success, but with one caveat: you contract an infection that was acquired attendant to that surgery.

That’s just bad luck, right?

That hypothetical is, well, anything but fictional in the world of medicine as it is practiced in California and elsewhere across the country.

Put another way: Any reader of this blog who thinks that infections visited upon patients receiving in-facility care are a singular anomaly in the medical industry needs to reevaluate that view after being introduced to some hard empirical evidence noting otherwise.

Like this, for instance. According to the Centers for Disease Control and Prevention, about four out of every 100 infection-free patients admitted to a U.S. hospital don’t remain in that salutary state while receiving in-house care.

Although quick consideration of those odds might lead to the conclusion that maybe hospital infections aren’t really such a big deal, a bit of extrapolation might temper that conclusion.

To wit: When the total number of admitted patients nationally is considered, that four-percent figure takes on a whole new meaning. According to the CDC, more than 720,000 patients suffered in-facility infections in a recent year.

And about 75,000 of them died.

Those figures understandably make medical infections a top-rung industry concern, especially because the following of strict protocols and care standards is intimately tied to a curbed infection rate.

In other words, infections are less of a problem in hospitals where negligent practices and behaviors are controlled to a comparatively high degree.

Because of a strong belief that greater focus and effort on infection control must logically yield improved results, the CDC calls infection reduction one of the “winnable battles” that medical authorities face.

There is mixed evidence regarding that assessment. A recent study shows improvement in some areas, with dismal results in others.

And, tellingly, the CDC has concluded that infection-curbing goals enunciated in a national plan enacted in 2009 have not yet been realized.