Causing death

[Hoju]

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Doctors are people like anyone else and people can make mistakes. Hopefully it does not happen often or to every doctor, but I am sure some patients die each year because of a mistake on the doctor's part. I assume working grueling hours can degrade your decision making capability or cause you to miss things. My question is: Could you deal with it and remain a doctor if you accidentally caused someone's death? I am not talking about undertaking a risky procedure to help someone who needs it. I am talking about mistakes or missed signs that should have been caught. Lets not focus on getting sued, having your license taken away, or malpractice insurance costs. Just focus on the moral dilemma.

Personally, I would feel extremely guilty. Whether or not to remain a doctor would be a hard decision, but I believe that I could do it in the end (after time to evaluate myself, possibly therapy, and training with OCD like persistence). On the other hand, it is hard to say how you will react in such a horrible situation until it happens.

 

[dally1025]

Making mistakes is just part of being a doctor. You are never going to catch every sign and symptom. The human body is far too complicated for a single person to completely understand. I would predict that every doctor has screwed up somewhere along the line and caused a patient's death but many probably never realize it. All you can do is end each day knowing you did your best with the knowledge at hand. Personally, I would feel extremely guilty but at the same time I realize making the occasional mistake or missing a bit of info doesn't make you a terrible doctor (within reason, I'm not talking about gross negligence). In fact, it would probably make you better as you would pay better attention next time.

 

[Virgil]

Making mistakes is just part of being a doctor. You are never going to catch every sign and symptom. The human body is far too complicated for a single person to completely understand. I would predict that every doctor has screwed up somewhere along the line and caused a patient's death but many probably never realize it. All you can do is end each day knowing you did your best with the knowledge at hand. Personally, I would feel extremely guilty but at the same time I realize making the occasional mistake or missing a bit of info doesn't make you a terrible doctor (within reason, I'm not talking about gross negligence). In fact, it would probably make you better as you would pay better attention next time.

Quoted for Fuc*ing Truth.

To reiterate, you are going to make mistakes, especially when starting out. So long as your mistake was not due to negligence (like laziness/self interest or something), and you applied your best effort with the knowledge you had, it's all good in the hood.

 

[8744]

Doctors are people like anyone else and people can make mistakes. Hopefully it does not happen often or to every doctor, but I am sure some patients die each year because of a mistake on the doctor's part. I assume working grueling hours can degrade your decision making capability or cause you to miss things. My question is: Could you deal with it and remain a doctor if you accidentally caused someone's death? I am not talking about undertaking a risky procedure to help someone who needs it. I am talking about mistakes or missed signs that should have been caught. Lets not focus on getting sued, having your license taken away, or malpractice insurance costs. Just focus on the moral dilemma.

Personally, I would feel extremely guilty. Whether or not to remain a doctor would be a hard decision, but I believe that I could do it in the end (after time to evaluate myself, possibly therapy, and training with OCD like persistence). On the other hand, it is hard to say how you will react in such a horrible situation until it happens.

Someone has to be extremely sick to begin with for one of your mistakes to kill him. It's not like you will get some otherwise healthy 21-year-old who will die in week because of something you failed to diagnose or adequately treat. With the exception of pediatrics and obstetrics, medicine is almost exclusively the practice of geriatrics on an increasingly older and co-morbid population who feel (along with their families) that they can and should live forever, even in the face of a list of illnesses that is you cannot even imagine.

You are way over-thinking it. Therapy. Come on. You will need to grow a spine.

 

[LizzyM]

Read Healing the Wounds by David Hilfiker, M.D. It is out in paperback and used copies are ubiquitous, too. He deals with medical mistakes and the effect they have on the physician.

 

[Hoju]

Someone has to be extremely sick to begin with for one of your mistakes to kill him. It's not like you will get some otherwise healthy 21-year-old who will die in week because of something you failed to diagnose or adequately treat. With the exception of pediatrics and obstetrics, medicine is almost exclusively the practice of geriatrics on an increasingly older and co-morbid population who feel (along with their families) that they can and should live forever, even in the face of a list of illnesses that is you cannot even imagine.

You are way over-thinking it. Therapy. Come on. You will need to grow a spine.

I wasn't thinking about someone that is on the brink of death or even extremely unhealthy when I answered the question. I was thinking more along the lines of a mistake that unnecessarily killed someone that should have had a long life ahead of them. It that case, I probably would want someone professional or in the know to talk to about it, whether that be a therapist, colleague, etc. Just because I rock doesn't mean I'm made of stone.

 

[unsung]

Doctors are people like anyone else and people can make mistakes. Hopefully it does not happen often or to every doctor, but I am sure some patients die each year because of a mistake on the doctor's part. I assume working grueling hours can degrade your decision making capability or cause you to miss things. My question is: Could you deal with it and remain a doctor if you accidentally caused someone's death? I am not talking about undertaking a risky procedure to help someone who needs it. I am talking about mistakes or missed signs that should have been caught. Lets not focus on getting sued, having your license taken away, or malpractice insurance costs. Just focus on the moral dilemma.

Personally, I would feel extremely guilty. Whether or not to remain a doctor would be a hard decision, but I believe that I could do it in the end (after time to evaluate myself, possibly therapy, and training with OCD like persistence). On the other hand, it is hard to say how you will react in such a horrible situation until it happens.

I assume most docs in that situation probably rationalize it away. Yes, most of them that are conscientious (or simply decent human beings) probably feel very guilty. But people have spent so much time, $$, and energy into becoming physicians, the idea of dropping out of that profession probably creates this massive tumor of cognitive dissonance. Can't compute. In that situation, I think it's far easier to attribute the error/fault there to some external factor than to some internal incompetence.

This is especially true I think for non-lethal errors. Say, your primary doctor who failed to diagnose your rare condition and treated you for something else. Haven't we all heard stories of a patient who went around and around for years and years getting misdiagnosed by different people? Do these doctors feel bad? How bad do they feel? If confronted with their misdiagnoses, do they act defensive or actually admit their mistakes?

IME, docs, much like profs, are loathe to admit their mistakes, especially when they aren't lethal and eventually they're corrected for. Medicine/academia is just too hierarchical for docs to admit their errors, especially in the presence of nurses, medical students following them, etc. They risk losing their authority, so they always act like the hotshots. I experienced this richly as a grad student... Anyway, patients help with this because your average Joe doesn't know anything about science, anyway. So how is he going to call the doctor on his bluff when he is just guessing on a diagnosis and prescribing on a guess?

If you know nothing about medicine, then listening to someone go on and on about a diagnosis you might think wow, that person really knows his stuff... but the more I learn, the more I realize other people really don't know jack.

 

[nontrdgsbuiucmd]

In my limited experience, often there are procedures or double-checks within the system to limit the probability of deaths due to medical error.

An example of when this got screwed up was a few months ago, a local hospital admitted a person, put in an IV, and instead of changing it every 24 hrs or so (maybe the standard is more frequently than that even), did not change it for around 4 days, the patient died of a hospital-related infection. The hospital had a review to see what all went wrong that caused the negative outcome. But the person had been seen by how many nurses, doctors, techs, etc in 4 days?

My point is that I'd see the hospital and medical team as also having some effect on this, I know any one person can & will make mistakes, but an effective review/risk management program will stop the most frequent negative impacts by double checking things - no meds if the patient's chart and wrist band don't match, things like that.

I see medicine more as a system rather than one lone individual, responsible for every patient outcome..moral of the story - be nice to nurses so they aren't afraid to give you input regarding if you possibly screwed up!

 

[Law2Doc]

Doctors are people like anyone else and people can make mistakes. Hopefully it does not happen often or to every doctor,

It does happen to every doctor. Not always because of mistakes, but aggressive treatments carry risks, and in an effort to make someone better you will frequently make them worse. There will always be things you did or could have done that you have to wonder if it would make a difference in the unfortunate outcome. And yes, a good number will make bad mistakes that outright hasten death, particularly in the early training years. Things like putting lines, scopes, scalpels through structures they ought not be put through, are big examples. Doing major surgery on a not particularly stable patient because you feel the benefits outweigh the risks often results in a patient's demise. Misprescription of meds, dosages used to be the number one problem, but the safeguards are a bit better now. And not recognizing signs/symptoms or things on imaging or in labs can also lead to a patient's demise.

As Panda indicates, the typical physician will have a disproportionate number of patients who are old, frail and have multiple co-morbidities. A mere stomach ache in an old person could be nothing or the only tell-tale symptom hinting at their precipitous demise. You won't cure all, or even most of your patients. Many you won't diagnose. Many come to the hospital to die. You will likely question whether you are actually "helping people" at times.

If it was easy, med school and residency would each be a week long.

 

[Vihsadas]

Read Healing the Wounds by David Hilfiker, M.D. It is out in paperback and used copies are ubiquitous, too. He deals with medical mistakes and the effect they have on the physician.

Yeah, that's a great book. Highly recommended.

 

[8744]

It does happen to every doctor. Not always because of mistakes, but aggressive treatments carry risks, and in an effort to make someone better you will frequently make them worse. There will always be things you did or could have done that you have to wonder if it would make a difference in the unfortunate outcome. And yes, a good number will make bad mistakes that outright hasten death, particularly in the early training years. Things like putting lines, scopes, scalpels through structures they ought not be put through, are big examples. Doing major surgery on a not particularly stable patient because you feel the benefits outweigh the risks often results in a patient's demise. Misprescription of meds, dosages used to be the number one problem, but the safeguards are a bit better now. And not recognizing signs/symptoms or things on imaging or in labs can also lead to a patient's demise.

As Panda indicates, the typical physician will have a disproportionate number of patients who are old, frail and have multiple co-morbidities. A mere stomach ache in an old person could be nothing or the only tell-tale symptom hinting at their precipitous demise. You won't cure all, or even most of your patients. Many you won't diagnose. Many come to the hospital to die. You will likely question whether you are actually "helping people" at times.

If it was easy, med school and residency would each be a week long.

Of course, I did feel kind of bad when I gave a patient a pneumothorax after putting in a subclavian line...but **** happens.

 

[8744]

In my limited experience, often there are procedures or double-checks within the system to limit the probability of deaths due to medical error.

An example of when this got screwed up was a few months ago, a local hospital admitted a person, put in an IV, and instead of changing it every 24 hrs or so (maybe the standard is more frequently than that even), did not change it for around 4 days, the patient died of a hospital-related infection. The hospital had a review to see what all went wrong that caused the negative outcome. But the person had been seen by how many nurses, doctors, techs, etc in 4 days?

My point is that I'd see the hospital and medical team as also having some effect on this, I know any one person can & will make mistakes, but an effective review/risk management program will stop the most frequent negative impacts by double checking things - no meds if the patient's chart and wrist band don't match, things like that.

I see medicine more as a system rather than one lone individual, responsible for every patient outcome..moral of the story - be nice to nurses so they aren't afraid to give you input regarding if you possibly screwed up!

I'd like to see the evidence for changing IVs at a set interval. Every 24 hours? That makes no sense. While indwelling lines are a risk for infection, poking a new vein every day is probably as bad if not worse. Same with central lines. They used to want us to change them every 48 hours but think about it: If I change it over a wire am I not jamming a sterile wire through a contaminated catheter and just seeding the new catheter with bacteria? And what are we supposed to do, migrate around the patient going from right to left internal jugular, left to right subclavian, and right to left femoral every two days? Every central line stick is dangerous and has a risk for complications.