Get Inside Your Doctor's Head by Phillip K. Peterson

Author:Phillip K. Peterson
Language: eng
Format: mobi
Publisher: Johns Hopkins University Press
Published: 2013-02-18T21:00:00+00:00

* * *

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.

Donald Rumsfeld (1932– )

* * *

I wasn’t the infectious diseases consultant in Pamela Ferguson’s case. I learned of her tragic death several months later, from my colleagues.

It wasn’t clear to us what viral infection her primary care doctor had in mind when he saw Pamela the day before she was hospitalized. If he was thinking of the flu, he had that right. But it is unlikely that he was thinking of H1N1 infection—the swine flu. If he had suspected an H1N1 infection and had started the antiviral drug Tamiflu a day earlier, it might have saved her life. But in October 2009, when Pamela came to him, this was one of the “unknown unknowns.”

Nobody could fault Pamela’s primary care doctor in 2009 for not prescribing Tamiflu. But now we know that obesity is a risk factor for developing severe or fatal H1N1 influenza. Today, a wise physician who examined an obese patient with suspected flu would prescribe Tamiflu, or a similar antiviral drug, immediately. (To read more about H1N1 influenza and other emerging infections, see the appendix.)

All medical schools in the United States regularly hold “morbidity and mortality conferences.” The goal of these conferences is to improve the quality of patient care. Cases are presented of patients who suffered (morbidity) or died (mortality) as a result of medical errors.

The cases are usually presented as unknowns (that is, the final diagnosis is not revealed to the audience when the case is first presented). “Red herrings” (information that is not relevant to the case) are usually added, to throw the students, residents, and experts—the teaching faculty—off the trail to the right diagnosis. When the final diagnosis is disclosed, it often turns out that none of the experts had it right.

The main purpose, however, is not to stump the experts. Rather, it is to educate doctors so they will avoid similar errors in their own medical practices.

Occasionally, these errors aren’t the honest mistakes that all practitioners make, but are mistakes that represent medical malpractice—a deviation from the accepted standard of care resulting in undue injury to a patient. Malpractice is not common, but it is quite real.

About half of all physicians, regardless of their ability, are sued for malpractice at least once during their careers. A large percentage of these suits are dismissed or found to have no merit. Nonetheless, they cause enormous emotional distress—for both patients and doctors. A much smaller percentage represent malpractice. The main factor underlying many malpractice lawsuits, however, is not a violation of the standard of care but a poor doctor-patient relationship.

Applying Rule 8

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.