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Medical Errors in the ED

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Medical Errors in the ED

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ER medical errorsWhy are there emergency department medical errors? No one is perfect, including ED doctors. There’s not a physician alive who hasn’t failed to diagnose a patient or given the wrong treatment. Even TV’s Dr. Gregory House takes a dozen shots at a diagnosis before finally getting it right. (I would lose my job if it took me that many tries on a routine basis!)

Responsibility for multiple patients
Emergency physicians, unlike other medical specialists, actively manage the care of multiple patients who are present at the same time. We may be also managing patients who have been admitted and are waiting in the department for a bed to open on a hospital floor. No other group of physicians has to handle a dozen or more patients simultaneously.

Frequently we are faced with managing more than one patient with the same last name; more commonly, we have different patients with similar presentations and complaints who may ultimately have entirely different diagnoses.

One 60 year old patient with chest pain and shortness of breath may have cardiac problems, while another patient similarly aged may have pneumonia or a lung problem. Any physician managing both such patients at the same time is working at a disadvantage.

Errors may occur when a physician is obliged to provide care for too many patients at the same time. No matter how many patients we have, we ER physicians continue to see patients as they present.

Miscommunication
Nursing staff may fail to advise us of a change in the condition of a patient; something we should know “right away” may be information that doesn’t reach us. Often for the same reason: the staff have too many patients.

Noncompliance
What else contributes to errors? Patient non-compliance is a top offender. Patients complain when they don’t get better even though they neither take the medication we prescribe nor follow our treatment instructions. I clearly recall a patient I saw with an eye injury who complained about his failure to improve even though he didn’t even fill the prescription for drops I wrote!

ED medical errorsHe brings to mind another “pet peeve” – the patient who complains about the length of time for treatment knowing that we asked for a urine specimen that hasn’t been provided. Believe it or not, no one really wants to handle your pee. We order tests because we need them.

Patients withhold or fail to divulge information they should know is important. It’s your job to tell us the names of the pills you take – not their color. One patient with an STD complained about the lack of diagnosis when he failed to reveal his sexual orientation; something entirely pertinent, which any reasonable adult should have known.

Missed diagnoses
We also may miss a diagnosis when the patient presents so early in the course of the ailment there are few, if any, clues to the diagnosis. It may be very difficult to diagnose a patient with measles during the three to four days of symptoms before the rash occurs.

Bad results versus medical errors
Often, perceived errors are not errors at all. Not every patient’s disease can be cured; not every course of antibiotics will kill the germs. A bad result does not mean there was a medical error.

Some ailments defy diagnosis; I recall a patient whose diagnosis eluded several specialists. Somehow, he expected an ED doctor to diagnose him at 2 a.m. He came with unrealistic expectations, and left disappointed.

Some private practitioners, for whatever reason, try to bolster their standing with patients by putting down the emergency physicians. More than once I’ve heard stories of patients with minor ailments, properly diagnosed, being told by their family doctor, “Thank God you came to see me when you did! That ED doctor really screwed up!”

Attorneys are often prone to accept a medical malpractice case simply because they see damages (and thus, potential recovery) as large … and they then attempt to see if anything medical was done incorrectly.

No doctor, nor group of doctors, is perfect. Emergency physicians, by and large, are a pretty good group. Not everything labeled as a “medical error” really is a medical error.

Med League provides expert witnesses with expertise in evaluating emergency department malpractice cases. Call us for assistance.

 

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