Perspective: Stop! Think! Listen! “Cognitvie Pause” can reduce medical error
By Charles A. Pilcher MD FACEP
October, 2013
Most medical errors are caused not by lack of knowledge or an obvious mistake, but rather by thinking errors. These result in mis-interpreting the patient’s presentation as something more common, when unusual symptoms should give the physician pause. When the pattern doesn’t completely fit, when one or more symptoms or signs suggest something isn’t right, it’s time for a “cognitive pause” to give the brain an opportunity to “reboot.” Most ED docs experience such a situation only a couple times a shift. Acknowledging one’s incomplete comfort with a diagnosis is the key step, followed by a brief consideration of more serious alternatives. Taking an extra 5 minutes per shift to do this can keep a doc out of court for a lifetime. More ->
More on stroke: Spinning the news like a top
Early treatment with tPA works best (duh). This article in Stroke says that treatment within 90 minutes is the best. But the report is a great example of “spin” in stroke studies, with selection bias playing a huge role. The biggest confounder in this study is the fact that many “early” strokes turn out to be TIA’s and not strokes. Another report in Lancet headlines only the “good news,” i.e., patients may do better if they survive, but “…[T]hrombolysis with intravenous alteplase for acute ischaemic stroke does not affect survival.” And check out last month’s “Perspective” for more on the subject.
Refusing tPA requires informed consent: Coulon v Creel – Louisiana
The wife of a 65 year old man heard him fall and found him on the floor 15 minutes later with slurred speech and right arm paralysis. Within the next 90 minutes, he was seen in the ED, a radiologist confirmed a CVA on CT scan, and he was admitted. He sued for failure to give tPA AND for failure to give informed consent about tPA. The jury found no medical malpractice, but awarded $150,000 for failure to give informed consent. [Editor’s Note: Specific cases are usually not a subject of this newsletter, but this one is novel. Source: malpractice email alert. No further information.]
Physician leaders, supervisors, at greater legal risk; communications faiures cited
Alicia Gallegos wrote a nice summary in American Medical News of the extra risks incurred by physician supervisors and team leaders in med mal suits. Recent research highlights the effect failed teamwork can have on care. A 2013 Joint Commission report found that poor leadership was involved in 901 sentinel events investigated, and poor communications in 59%. “When health care team members drop the ball, it’s often doctors who end up in court.”