Do complications make you a bad doctor?
It's 3 am in the morning. Into Happy's ED comes a 92 year old female, with son in hand claiming they will never "go back to that other hospital because that's where the bad doctor is."
It's 3 am. I just had to know what he was talking about. So I asked. He said a doctor "poked a hole in my mom's lung while trying to put a central line in."
Mind you. It's 3 am. I explained.
"Sir. That does not make the doctor bad. That is a complication of the procedure. Every doctor, has at some point or another caused a lung to collapse from putting in a central line. If they haven't, they haven't done enough of them. Even I have 'poked a hole' in a lung."
Complications are part of medicine. We spend 3-7 years of residency and fellowship learning to manage complication of disease, not the disease itself. Anyone and a text book can manage protocol medicine. It takes a physician to manage the complications. There are no shortcuts in that regard.
Good for you for speaking up for the guy.
ReplyDeleteI would definitely feel like someone who screwed up a procedure was a bad doctor. It may be a statistical possibility, and happen to everyone, but when you're the patient or family member, that means nothing. I've made plenty of mistakes and felt like a "bad nurse" at those times. Every single one of my patients have central lines and I've never heard of any lungs being poked.
ReplyDelete"That does not make the doctor bad. That is a complication of the procedure."
ReplyDeleteOr it could mean the doctor was inexperienced. Such as in my case when an intern 3 months out of medical school was allowed to make 3 painful attempts putting in a central line before finally admitting defeat and calling in the chief resident who got it in one try. This could have been the scenario with your 92 year old patient, except maybe her previous doctor didn't want to admit failure and unwisely continued until causing injury to the patient.
The biggest complication of this case is putting a central line in a 92 year old.
ReplyDeleteIf your sick enough at 92 to require a central, its time to talk about other options.
I've put in close to 1,000 central lines
ReplyDelete1 Pneumothorax, somewhere around the 100 mark when I got a little cocky and tried doin one right handed...
I was totaly honest with the patient and family...
I meant to do it... she had a positive PPD, lowering that O2 tension...
Put in the chest tube too...
Left handed.
Frank
Mentioning an age is not a HIPAA violation. You people are out of control with that nonsense.
ReplyDeleteWe just recently had a HIPAA in service and mentioning a specific age in someone older than 90 or less than 1 year old IS a HIPAA violation. You'll find many bloggers have brought this up in the past.
ReplyDeleteSorry, but that's wrong. Mentioning an age in conjunction with a location is a potential HIPAA violation, but you have no idea where Happy works. Since there are tens of thousands of 90+ patients in the country, I doubt you have any idea who the patient is.
ReplyDeleteCan't violate privacy of somebody if you have no idea who it is. Again, the extent to which people will try to nitpick about HIPAA is ridiculous. I don't care if you had an inservice, outservice, selfservice, or whatever. The facts combined with common sense aren't a strong suit of many people including those who "teach" others.
Happy,
ReplyDeletedid you here the one about the Medicine Resident who put an IJ line in the Carotid?? I don't mean he STUCK the Carotid, anyone can do that... but actually put it in the artery, sewed in and dressed all neat like y'all are...
Took an RN to point out the arterial wave form on the monitor and the joker still wouldn't pull it till he got a blood gas...and even then he wouldn't pull it, he called a surgery resident to pull it, which happend to be me, cause I was doin ICU that month...
I'd have left it in, billed for an A-line...
And this was Pre-Hippa,
Frank M.D.
Worth mentioning, however, that our central lines are all scheduled placements under ultrasound guidance, which I know totally changes the playing field complication wise.
ReplyDeleteI don't think anyone feels that having a complication makes someone a bad doctor. I do, however, think your reaction was harsh.
I saw a Medicine Resident drop a lung putting in a Central Line...Could happen to anyone, right???
ReplyDeleteIt was a femoral line....
I've tried it with the ultrasound...too much trouble, do they not teach anatomy anymore???
2 Questions Happy...
1: Was it a subclavian or IJ???
2: Do you ever work a shift without pissin anyone off???
Frank, M.D.
It was a PICC line Frank.
ReplyDeleteI'm sure you vetted your grandmother's surgeon before she underwent her eye surgery. It's doubtful you sacrificed her wellbeing to a novice so he could learn by his mistakes to benefit his future patients. And then you take umbrage that a regular patient is not understanding of a doctor's learning process.
ReplyDeleteMost people I know in the medical profession
(including myself) take advantage of our connections and make sure that we (and our families) get the top-notch professionals when we are in medical need. Don't dance around the fact that there is a double standard in hospital care.
How do you drop a lung with a PICC line??
ReplyDelete"How do you drop a lung with a PICC line??"
ReplyDeletecan be done with aggressive use of the guidewire; or if the pt has particularly "fragile" lungs (bad copd). I'm an Rn, used to place PICCs. Never dropped a lung placing one, but there are instances in the literature.
Anon 9:05
ReplyDeleteYou meant to say Central, right? Frank is talking about dropping a lung... so insertion site... or I guess you'd have to be using a coat hangar almost?
-Second career nursing student
Does A Complication Make You A Bad Doctor?
ReplyDeleteFrom family and patients point of view, yes.
if the complication is diagnosed on time, even if the patient dies, the doctors did their job, whne you do a procedure and have a complication, not diagnosing it, makes you a bad doctor.
the more you practice, the best you do. we all know that, when psicomotory skills comes to play, the only way to learn is by practicing on patients, when we have the right technology to practice properly before practice on real patients, i guess we can reduce the number of potential screws while learning.
most of people believes that doctors are god, they are all mighty, doesnt make mistakes, which is false,
OK the patient was frustated and stressed, like every other patient, everyone feel like the victim except for the doctor, because he is the one that knows it all, the patient is always right.
Frank it was a joke, I think the sevo vapors are getting to you.
ReplyDeleteYou know, as I was telling my 94 year old hispanic female patient and her daughter Maria, that ever since the patient's left-sided mastectomy scar deleveloped that funny rash (not unusual here in the Las Vegas heat--and we see it all the time , being the only Level One Trauma Center here in town with a 7th floor family care unit) "Ya really have to watch what you say due to HIPAA!"
ReplyDeletePattie, RN
See? Now that would be a HIPAA violation. Thanks for making it obvious to the oblivious, Pattie.
ReplyDeleteAnon 805--
ReplyDeleteDarn! I was waiting for Christine-Megan to get her panties in a wad, and you had to "out" me!
Pattie, RN
I have seen a pneumo caused by a bronch, central line, and I have only been a nurse for 3 yrs, but I agree that stuff happens, and medicine is called a medical practice for a reason, nothing is 100%, doctors are not gods, if they were you would be healed instantly and not admitted to the hospital. Life is life, things go wrong. I think what the poster wrote about acknowledging it as a mistake, and showing empathy for the mistake does go far when you have a nervous family and pt, they do appreciate it alot; then they know they can trust you. I understand the part about being up a 3 am, and being frustrated though. I work nights and it can be hard. You work hard, try to stay positive despite long hours, and educate the best you can, and you'll get good things back in return.
ReplyDeleteanon 747. That was a very nice comment. Thank you
ReplyDelete"The facts combined with common sense aren't a strong suit of many people including those who "teach" others."
ReplyDeleteI love you, anonymous. Let's run off and get married.