Handling giagnostic errors

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  1. Attending Physician
How are errors handled in your practice? What are non-acceptable mistakes? When do you fire somebody for a diagnostic mistake?
I heard about a junior pathologist that consulted with the senior before sign out, made a mistake and the junior was fired, insights please
 
How are errors handled in your practice? What are non-acceptable mistakes? When do you fire somebody for a diagnostic mistake?
I heard about a junior pathologist that consulted with the senior before sign out, made a mistake and the junior was fired, insights please

You mean like typos?

ETA: That sounds like they wanted to get rid of that person anyway. People make mistakes. You try to avoid them and have to know how to handle them. I've seen very experienced, wise, senior pathologists be confronted with mistakes, and the ones I have the most respect for handle it right away and see if there's any damage to fix. The ones who I absolutely have NO respect for try to blame everyone else.
 
No, not like typos. For example; the junior attending harrases the senior to review a difficult case; the senior is too busy; junior signs out the case and when case is reviewed senior founds something that was missed; junior is removed from service immediately; attending went straight to head of surg. path; head of surg path puts junior to cover frozens for a complete month; the junior's books and diplomas were removed from office without letting him/her know before. Any advice on how to handle that? would you continue to work in a place like that?
 
How about reporting an ER-/PR+ breast cancer? Is that a reason to fire somebody? Senior attending on service was tired of having clinicians called with questions about cases (clinicians were used to talk to the senior; especially a very demanding and bit paranoid oncologist) and he/she felt that it was easier to handle cases than review difficult cases with junior first. Please note that this junior is real bright, likeable and well trained. Tips on handling such situation
 
No, not like typos. For example; the junior attending harrases the senior to review a difficult case; the senior is too busy; junior signs out the case and when case is reviewed senior founds something that was missed; junior is removed from service immediately; attending went straight to head of surg. path; head of surg path puts junior to cover frozens for a complete month; the junior's books and diplomas were removed from office without letting him/her know before. Any advice on how to handle that? would you continue to work in a place like that?

Why didnt junior wait for the senior to review the case? There should be some communication as in "I am busy now but will get to the case tomm, two days, etc" or have the case brought to another senior?
 
junior was being pushed by clinician o issue a report; senior was really hard to get and there were the two of them in that service
 
How are errors handled in your practice? What are non-acceptable mistakes? When do you fire somebody for a diagnostic mistake?
I heard about a junior pathologist that consulted with the senior before sign out, made a mistake and the junior was fired, insights please

There is MUCH MORE to the story than you are telling us.

When you consult a senior pathologist, their name is on the report (or def. should be).

Errors are part of ALL practices, academic, public or governmental and private. No one is usually fired for them.

My guess is: the "junior attending" is a foreign non-native born pathologist. Right?

He/she has some communication difficulties as English is not their first and by no means best language. Right?

The group location is some large public health care set up like a county hospital or VA where the staff had very little input on who was hired. They are resentful for this and take it out on new guy/girl.

I think Ive cracked this little story wide open, Dr. Watson.
 
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Depending on the real and full extent of the story, I doubt I would want to work in such a place. I'm not real fond of someone meddling with my personal belongings in my office. I'm also a little perplexed at the rationale behind taking someone "off-service" (because their abilities were in question? to punish them for something?) and putting them on frozens where consultation is typically more difficult to obtain and decisions lead to immediate consequences.

As for consultations, one really doesn't get to say they consulted about a case without actually doing so. And if you do so, it only counts if you document that you did so in that report. I've heard of cases where a junior showed a case to a senior before signing out (inaccurately as it seems to be) and the senior claimed they were only shown certain slides or certain fields on certain slides (which of course aren't the relevant slides or areas for the "mistake"), effectively trying to throw the junior under the bus. It's also quite possible for the senior to just be wrong -- nothing says a newbie board certified pathologist is automatically wrong while an oldie is right. Signing something out because you can't rapidly get a consult isn't likely to get you off the hook. I -have- heard of people who sign something out as pending consultation or somesuch, which apparently was simply a way to shorten calculated turnaround times; they amended the report with the final later.

Edited to add: As for mistakes, as one of our contracted teachers liked to come in and say, the acceptable error rate for a pathologist is zero. Everyone knows that humans are prone to errors of all sorts, but the level of tolerance of them in pathology is excruciatingly low. Private practices can generally terminate someone more easily than other employers, but it depends on the contract, what they say they're firing you for, and applicable law.
 
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No, not like typos. For example; the junior attending harrases the senior to review a difficult case; the senior is too busy; junior signs out the case and when case is reviewed senior founds something that was missed; junior is removed from service immediately; attending went straight to head of surg. path; head of surg path puts junior to cover frozens for a complete month; the junior's books and diplomas were removed from office without letting him/her know before. Any advice on how to handle that? would you continue to work in a place like that?

Um, yeah. It's probably not that simple. Why is the senior too busy to review a difficult case? Isn't that part of his job? Or is it because the junior has him review every single case that comes across his desk and he is too busy for that? Maybe that's why the junior was fired. Not because of the one case, but because of all the cases. The one case with the big mistake makes it easier to fire over though I suppose.

Most doctors do not get fired over making mistakes. They get sued. If they make particularly egregious mistakes or attempt to cover them up, or they make repeated mistakes, then they get fired.

And if this person is getting "fired" why are they now covering frozens? That's not really a great idea. This person can't be trusted to make diagnoses so lets throw them into a situation where they have to make lots of critical and timely ones. OK, sure. That sounds plausible.

Sounds more to me like a communication problem. Mainly, the junior attending is a poor communicator and more than likely has poor insight. The senior may or may not have similar problems.
 
junior was being pushed by clinician o issue a report; senior was really hard to get and there were the two of them in that service

What the hell kind of relationship exists in this department anyway? You can't knock on the door and say, "excuse me, sorry to bother and I know you are busy, but this is a critical issue and I need your input." I feel really horrible for the patients at this institution if their care is being put to pasture just so certain people can feel better or feel less stressed out. Yikes.
 
As a new grad I worked in a PP group where the partners were so unfriendly and were never interested in helping me as the junior associate. I would ask for an opinion on a case and certain pathologists would leave it on their desk for days - just rude and totally unacceptable. Physicians working together in a group should be there to support and help each other. Now I work in group that embodies that ethos and life is so much better. Life is too short to work with a_ _ holes for any amount of money. PS these individuals had inflated self-opinions, thought they knew more than they actually did and apparently trained in some malignant east coast programs and they transmitted that vibe into the practice. I'll confess that I really have a bias against docs that have an "old-school" suck-it-up attitude. That's just not me.
 
Yes; junior had a heavy accent, the setting was a real busy and quite malignant place; still I believe more kindness would have been better
 
Frozens were done at a building far from most offices and were a lot of them; so nobody really wanted to do them; also longer hours were required; seniors were busy but also disrganized and really did not have any interest in seeing cases with a junior and new person; also were very concerned about keeping their status with clinicians and not introduced/promote the junior at any level
 
Apparently seniors were too busy to do frozens; junior was called many times to cover for the senior's frozens because they were in administrative meetings or conferences. One of them once expressed to junior that his/her presence was not important at a teaching conference; so junior was sent to do frozens
 
Sounds like a hellish, non-collegial and very abusive place.
 
most of new hires left within 2 years; which is at least suspicious
 
As a new grad I worked in a PP group where the partners were so unfriendly and were never interested in helping me as the junior associate. I would ask for an opinion on a case and certain pathologists would leave it on their desk for days - just rude and totally unacceptable. Physicians working together in a group should be there to support and help each other. Now I work in group that embodies that ethos and life is so much better. Life is too short to work with a_ _ holes for any amount of money. PS these individuals had inflated self-opinions, thought they knew more than they actually did and apparently trained in some malignant east coast programs and they transmitted that vibe into the practice. I'll confess that I really have a bias against docs that have an "old-school" suck-it-up attitude. That's just not me.

Well said.

But you can have an old school suck-it-up attitude and still be collegial and helpful. Some of the most old school are the most helpful if they trust your opinion also and think you know what you're doing. My group is mostly older folks and our resident curmudgeon comes to me now with tough cases. He is definitely old school and complains when he gets too many cases shown to him but never refuses anything. You just know what he thinks of you but what he decides to show you and trust you with.
 
...our resident curmudgeon comes to me now with tough cases.

Winning! 👍


KCShaw said:
I -have- heard of people who sign something out as pending consultation or somesuch, which apparently was simply a way to shorten calculated turnaround times; they amended the report with the final later.

We see lots of consults sent to us where the outside pathologist has signed out a report but with a comment that it is pending consultation. Seems to be a common (and reasonable) practice. Although, I would add that it might be better to wait if you really have no idea what something is. If you are pretty sure but just want to have an expert confirm it, then it seems reasonable to sign out but say "pending consultation". Just my opinion.
 
No, not like typos. For example; the junior attending harrases the senior to review a difficult case; the senior is too busy; junior signs out the case and when case is reviewed senior founds something that was missed; junior is removed from service immediately; attending went straight to head of surg. path; head of surg path puts junior to cover frozens for a complete month; the junior's books and diplomas were removed from office without letting him/her know before. Any advice on how to handle that? would you continue to work in a place like that?

I would be a homicidal manic with a flamethrower if they touched my books and diplomas without telling me. Hammers for fingers and spoons for senior attending's eyes is how that would go down. Where do there critters come from? Didn't that infuriate anyone, where is this cesspool at?? 😡
 
I have to say, I am drawing great amusement from the title of this thread. I might have to start using the term "Giagnostic errors" for big time mistakes. I'm sure it was an accident and the OP meant to say diagnostic, but giagnostic just works so much better.

I called that SFT a sarcomatoid mesothelioma on frozen. What a giagnostic error.
 
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