In this issue:
- Perspective: OOPS! Why do doctors make diagnostic errors?
- Surgical errors still occurring “far too often” despite protocols
- Patients trust a CT scan 4 times more than they trust the doctor
- “Handoffs:” Reducing the error of a high-risk practice
Perspective: OOPS! Why do doctors make diagnostic errors?
By Charles A. Pilcher MD FACEP
Error occurs. About 5% of autopsies find clinically significant conditions that were missed and could have affected the patient’s survival. And 40% of malpractice suits are for “failure to diagnose.” These aren’t “system errors,” but “thinking errors.” American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them. The article focused on “thinking mistakes” and was both refreshingly honest and depressingly true. The biggest problem is getting too focused too soon. Read more ->
Surgical errors still occurring “far too often” despite protocols.
While the above “Perspective” discusses how “thinking errors” lead to diagnostic errors, an article in Archives of Surgery indicates that despite all our efforts we are making little headway with “system errors” either. While standardized protocols are designed to prevent surgical errors, mistakes like wrong-site or wrong-patient operations continue to occur, and may in fact be on the increase. The paper’s lead author, Dr. Philip F. Stahel, called the findings “shocking.” [Editor’s note: Reminds me of the pilot who landed with the wheels up and excused the mistake with the words “But the checklist was complete!”]
Patients trust a CT scan 4 times more than they trust the doctor.
Every physician today feels that patients trust technology more than they trust their doctor. This is by far the #1 reason for the astronomical rise in health care costs. An example appears in a December article in Annals of Emergency Medicine. The authors report that ED patients with acute abdominal pain are four times more confident that doctors have correctly diagnosed their conditions after a CT imaging study than a diagnosis based on history and physical alone. In a study of 1168 patients, the confidence level of patients rose from 20% to 90% following a CT scan and blood work. Of note is that of 75% of the patients surveyed underestimated the risk of the radiation associated with a CT scan.
“Handoffs:” Reducing the error of a high-risk practice
A “handoff” (the transfer of care from one physician to another) is a high-risk event. Most ED’s in the Pacific Northwest use the “handoff” rarely, meaning that each ED physician admits or discharges all patients he/she started. However, there are always situations where a doctor begins a workup at the end of a shift out of courtesy to the patient and oncoming doc, or in event of life-threatening emergency. When that happens, a transfer of care to a second physician – aka a “sign-out” or “handoff” – occurs. In order to minimize the risk in such situations, a standardized handoff protocol is recommended by the authors of an article in the December issue of Annals of Emergency Medicine.