"DC Paramedics make Fatal misdiagnosis"

[HellsBells]

crotchitymedic I fail to see what purpose a supervisor talking to you over the phone would serve. If a pt is of sound mind they can choose not to go to the hospital, you can't force someone who has made up their mind not to go.

However, if I believe that a pt is in serious trouble, I will do everything in my power to convince them to go, including calling a doctor and having him try to convince the pt to go. If the pt still doesn't want to go document well and obtain a signature.

[firedoc5]

If you have that many supervisors you're going to end up promoting someone who has no business leading and is just as likely to make the mistake you're trying to prevent just to fill a hole.

Reminds me of a quote from a children's book my fiance has "Ozma of Oz" (Wizard of Oz series)

"I have in my army eight general," said the Tin Woodman "six colonel, seven majors and five captain besides one private for them to command. I'd like to promote the private, for I believe no private should ever be in public life."

If every second person is a supervisor it really just removes all accountability from those that aren't. "Not my problem, I called the supervisor and they decided."

Here's my question though. With all the medical errors that occur daily around North America, what is it about the way we f-up that it makes the news over the others? What could we do differently so that our medical errors can be dealt with in such a way that our patients and their families don't feel like they have to go to the media just to get accountability and improvement?

I know that book. Reminds me of too many Chiefs and not enough Indians.

Unfortunately errors happen. It's human nature. Some are little boo-boo's and some are major mistakes, but they are all errors. No matter how much education and training, it's going to happen.

Doc, isnt' it said that we only use something like 5-8 % of our brain compacity? If so, and one day we could use more than that, there will still be mistakes made.

I see it a lot more of things being double checked and other preventive procedures, that if followed could help to lower the number of errors. But not everybody does those procedures. So that's one thing that needs to be enforced.

[WolfmanHarris]

I agree entirely, but while reducing medical errors is important, that wasn't what I was driving at. My questions had more to do with the management and on-scene attitudes side of things, AFTER the error. Specifically, what is it about our medical errors in EMS, that draw the media on us over other fields? How can we manage our error reporting and the way we deal with the aftermath better so that the media isn't the the first outlet for satisfaction by the family when we screw up?

Edit: Actually HellsBelles makes a point in another thread that makes me reconsider this a bit. Maybe it's not that we're reported on more as much as it is the news sources I read and the stories that stick in my memory. My questions still stands as I think it's valid, but it's given me something to think on.

- Matt

[crotchitymedic1986]

I dont know that our errors are any more publicized than any others. You hear about every time someone finds something in their hamburger and sues the restaurant, or when a hospital is sued. So when we are sued, it makes the same headlines.

But the problem with us is that our errors result in death -- if the kid forgets to take the onions off your hamburger, you take it back, get a free one, end of case

[WolfmanHarris]

Once again I wasn't comparing our errors to a printing error in the newspaper, a burger flippers screw up (which can kill), or any other job. I was talking about EMS medical errors vs. other medical errors. And ours have less potential to kill than say a Surgeon when you factor in all the possible mistakes they can make?

And like I said above, I might be wrong on reporting as my view is likely more skewed than I realized. But whether we commit more or less than RN's, RT's, MD's or any other Healthcare provider, we do have a responsibility to examine how we handle those errors and whether we are addressing them with a mind to prevent further similar errors, improve quality of the system and treat those affected by our errors with due compassion and accountability such that perhaps our bed press can be diminished. (Maybe, just maybe)

And yes, before it comes up, proper education is the biggest and most important point. But other than that what can we do?

[crotchitymedic1986]

Good points doc, but the problem is that our errors do result in death, so you can bet on a lawsuit when they occur. If a medic at your service killed my kid, you can display all the compassion and remorse you want to, and even if i believe it to be sincere, I would probably still sue.

And to those who wish to call me names, that is fine, that is what most people do when they can not argue with logic, they attack the messenger.

Although I applaud Doc's thoughts about managing the situation better, I think we would be better served to figure out how to stop the mistakes from happening. You have several high profile examples of these types of errors from DC alone. If you dont like my method, how would you stop this from happening ?

[WolfmanHarris]

Okay... how about:

1) National EMS Medical errors and near misses reporting. Similar to FAA encourage providers to report errors in a non-disciplinary environment centred on risk management and education.

2) Encourage Quality Improvement (QI) over Quality Assurance within a service. Encourage management to move away from disciplinary action as the only outcome to a mistake. Encourage teaching and continuing education from Medical Director and Management down such that providers feel safe in their jobs reporting their own mistake, receiving guidance and if necessary CME to prevent it. This doesn't preclude canning someone or suspending them if they really screw up, but encourages development.

3) Learn from what's been found about Physician malpractice suits and consider dropping some of the CYA. I can't find the research to back this up with a quick google search but I have heard it referenced in a few places. (LINK) Consider admitting responsibility and apologizing, rather than saying nothing and hiding behind the "ungoing investigation" defense. An interview I was listening to on CBC's "White Coat, Black Art" (excellent radio show btw) a few month ago had a malpractice attorney discussing how even in the face of gross negligence, a Physician who was upfront and compassionate with the family has the most reluctant plantiffs, even when significant damage has been done. If we can strike a balance between preventing litigation and being responsible for our action with the family, perhaps we can diffuse some of the anger.

4) Continuing education. Fight complacency in your own practice and you might avoid BS refusals and half-assed assessments which result in things being missed. If you know what's going on you're going to be more able to convince your patient.

5) Compassion and communication. If you care about your patient and can communicate that, they may be less likely to refuse based on them not liking their care. If you treat your patient like garbage from beginning to end and they believe you don't care or take them seriously are they not more likely to refuse and find another way (if any) to access treatment?

What do you think of these? Just a few spitballed ideas I've ripped off from lecture, JEM's and other reading.

[crotchitymedic1986]

Doc, I have to admit, thats pretty damn impressive on short notice.

[WolfmanHarris]

Exams are done and no school until Jan 12. So I'm studying and killing time until I go visit family on the 23rd. Plus I can't take credit, they're all ripped from other sources I remembered.

[crotchitymedic1986]

But I wonder how you could motivate companies or individual medics to tell on themselves by reporting these numbers, as the general rule is to cover-up and deny it when you can. There is no "reward" for reporting the errors, and some could argue that you could open yourself up to a lawsuit by doing so. We should want to know the true number of EMS mistakes that harm patients, but I doubt many would be willing to share their true numbers.

Think about the number of medication errors that happen on an annual basis alone (where no harm was to done to the pt).