Killing a Patient?

[Sed8&Intub8]

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To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day. I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

 

[greg1184]

It is natural to feel that way, especially for the more invasive specialties. However you got to realize that this is the reason why you go through many years of strenuous training in order to reach that level.

 

[spicedmanna]

To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day.

According to one study, in-hospital medical errors caused on average 195,000 deaths per year (2000, 2001, 2002) in a survey of 37 million medical records (1). Medical mistakes and iatrogenic deaths happen. It's a real serious concern.

I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

In the course of your training and your career, you will make mistakes, miss something, and make bad calls. Sometimes patients will die. These are the subjects of M&M meetings. You study what happened, learn from it, and try to avoid the error or oversight in the future.

You do your best as you go about your business to minimize errors. You develop a good system for the things that you do and try to do it the same way, consistently, so that nothing gets missed. There are also a number of checks in place in a hospital setting. However, even with all the checks and systems you employ, errors will happen and bad calls will be made. It's inevitable. We do what we can to prevent the errors that can be prevented, but you can't go around being ultra-paranoid about everything, or it will certainly compromise on your ability to care for your patients. As a student or a resident, you practice under the guidance of those ahead of you and they have to review or approve almost everything you do, so there is that little bit of reassurance, at least for now.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

Of course. Most everyone feels the gravity of the job. You just do the best that you can. You just have to realize, that even with all the care we take to do things the right way and to not make a mistake, errors will happen. By creating your own system, doing things the same way consistently, and with experience behind you, you minimize committing the preventable ones. With time and experience, you begin to trust yourself more. Basically, you have to measure yourself against the current standard of care and ideally what a person with your same level of training would reasonably do under the same circumstances. If you truly care about your patient, you are going to do what you can and the best that you can. I don't think anybody can ask more of you. Feeling some fear is fine; it keeps us on our toes. However, if you let your fear get out of control, it will run your life and paralyze you. Counseling can help if your fear is consuming you.

 

[45408]

Unless you are in a specialty with no patient contact, you will have patients who die. You'll be dealing with sick people for your entire career, and sometimes they will die from their diseases. It is possible that they will die because you didn't catch their disease soon enough, and it's even possible that you'll do something that hastens their death. Sometimes that's negligent, other times it's just part of medicine. Physicians often have to make split-second decisions with limited information which may turn out to be wrong or inadequate. Many times, a patient will simply come to you with a disease that is too far advanced.

Try not to worry about this as a pre-med. You'll have many years of training before you are completely on your own, so this kind of concern shouldn't keep you from the field entirely.

 

[avksx]

Be sure to promote preventative medicine for any and all you come into contact with.

 

[ITreat]

According to one study, in-hospital medical errors caused on average 195,000 deaths per year (2000, 2001, 2002) in a survey of 37 million medical records (1). Medical mistakes and iatrogenic deaths happen. It's a real serious concern.

If you use lawyer stats then "malpractice kill more than cancer and cardiovascular diseases combined" lol

The way I think about it is that I do my best in school and in training then I can say I gave them the best shot. Everything has risk, look at driving...

 

[URHere]

The medical profession comes with a great deal of trust and responsibility, and it's only human to worry that, at some point, you will let someone down. When it comes to medicine though, letting someone down often has the added guilt of worsening illness or death tied to it.

You can work hard and study thoroughly, but eventually you will be too tired, too inexperienced, or unlucky to make exactly the right call. In some cases, even all the skill and attentiveness in the world won't be enough to save a patient because very few treatments come without risks of their own. It is possible that you will prevent a patient from losing their life to a massive stroke or PE, only to find that they end up bleeding out through a GI ulceration and dying anyway. If you do what you can, and you act in the best interests of your patients, then you just have to learn to handle the rest. You are human, and I think the best way to handle the stress is by accepting that.

 

[RogueUnicorn]

you probably won't kill someone that wasn't going to die already...

 

[csmittyB]

you probably won't kill someone that wasn't going to die already...

I doubt that argument would comfort the family or appease the courts.

 

[RogueUnicorn]

I doubt that argument would comfort the family or appease the courts.

good thing i didn't direct it at either of these two entities.

 

[spicedmanna]

you probably won't kill someone that wasn't going to die already...

In some instances, yes, but I have seen some truly horrible atrocities and close calls because of errors that were propagated or complications from interventions that were performed. Hospital stays and ED visits are not necessarily benign. I sometimes think to myself that a given patient might have faired better having not stepped foot into the hospital at all. I've seen situations where we definitely made a patient worse than when he came in when we could have just left well enough alone, or because an error was committed during a non-emergent procedure, introducing a complication. It's not a question of death sometimes, but of the quality of life for a person, especially when they are near the end. There are risks associated with every interventions and errors do happen. We do our best to avoid them, but sometimes we just can't. When we make preventable mistakes, we try to learn from them and fix what caused the problem.

 

[ahmcadams]

you probably won't kill someone that wasn't going to die already...

No, over the course of a career you likely will be responsible for the death of someone who, under another physician's watch, would have survived.

Doctors are only human. They make mistakes just like anyone else. The best you can do is to try and minimize your own errors and be cognizant of the fact that they will occur, often repeatedly.

 

[csmittyB]

good thing i didn't direct it at either of these two entities.

Fair enough. I may have been missing some sarcasm in first post b/c everyone dies, it is the ONLY thing guarenteed in life. The issue is whether the physician speed that eventuality up or not.

 

[spicedmanna]

Basically, what it comes down to is that medicine isn't for the faint of heart or stomach or mind. If you can't handle the pressure of holding a life in your hands and constantly live in paralyzing fear of killing a patient or making some grave mistake, then perhaps it would be wise to take a good look at yourself and ask whether medicine is really for you.

 

[da8s0859q]

To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day. I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

I never worried about that pre-matriculation. I assumed from the start that despite my best intentions and conscientiousness, I'll inevitably make some mistakes. I just hope that my ****ups are relatively minor and don't cause the kind of damage that mistakes can cause.

Medicine is inherently flawed because its practitioners are inherently flawed, and there isn't a thing you can do to change that. All you can do is do your absolute best -- but I'm being redundant.

 

[mvenus929]

you probably won't kill someone that wasn't going to die already...

One of the patients I worked with some months ago came in for a routine cath lab procedure, and they nicked his heart in such a way during the procedure that he needed emergency heart surgery. What started as a 2 day hospital stay ended up lasting weeks, and I'm still not sure he fully recovered.

Another patient of mine was undergoing gyn surgery and was given too much anesthesia, and so her hospital stay was prolonged due to her reaction to it.

There's also one of my interview questions, which is missing a diagnosis like meningitis during an exam because you didn't take the full steps to rule out the diagnosis.

 

[debvz]

you probably won't kill someone that wasn't going to die already...

Tell that to the family of a woman coming in for a prophylactic laparoscopic oophorectomy who wound up with a trochar through and through her colon and aorta.....

(she lived)

 

[MilkmanAl]

Anesthesiology is at the top of my list at the moment, so I've pretty much accepted that I'm going to kill people every now and then. That doesn't mean it won't suck horribly when it happens, but like spicedmanna said, it's a risk you accept when you enter the profession.

 

[tkim]

You're allowed two clean kills per year in residency. Any more than that and you are subject to review.

 

[avksx]

You're allowed two clean kills per year in residency. Any more than that and you are subject to review.

Is there seriously a set number?

 

[tkim]

Is there seriously a set number?

It depends on the specialty. For EM, the number of very ill people we see is high, so while on the face of it - two dead people per year sounds horrendous, but it's relatively low.

Derm, however - only one death for all years of residency, because the acuity is so much lower.

Make no mistake, even one death is a reason to reflect and learn from.

 

[Sed8&Intub8]

This definetly makes me feel more comfortable about it. However, I am still very shocked that they have a set number of people that can die under your care before you get in trouble..

Thanks for all your input...

 

[tkim]

This definetly makes me feel more comfortable about it. However, I am still very shocked that they have a set number of people that can die under your care before you get in trouble..

Thanks for all your input...

You gotta be kidding me.

Dude ...

 

[ahowardmd]

.

 

[MilkmanAl]

You gotta be kidding me.

Dude ...

It's amazing, isn't it? Just using common sense, it's pretty clear that practicing medicine would be virtually impossible if you were only allowed to kill 2 people per year.

 

[Depakote]

You're allowed two clean kills per year in residency. Any more than that and you are subject to review.

do you get roll-over kills?

like if you don't use one during your PGY-1 year, can you save it if you manage to kill 3 your PGY-2 year?


edit: this is probably something to look for when choosing a residency program, I'd guess some programs offer this while others don't.

 

[tkim]

It's amazing, isn't it? Just using common sense, it's pretty clear that practicing medicine would be virtually impossible if you were only allowed to kill 2 people per year.

2/year is only a guideline. Some inner city, county programs - lots of pathology, lots of non-compliant patients - lots of dead people. Some of those programs can only *dream* of keeping it at 2/yr. You won't find that stat on a program website.

Actually, some of the other residents joked about saving them up and using their 'free-passes' - "freeps" on patients they didn't like. Very poor taste and quickly got the hairy eyeball by the PD who happened to have overheard.

 

[da8s0859q]

do you get roll-over kills?

like if you don't use one during your PGY-1 year, can you save it if you manage to kill 3 your PGY-2 year?


edit: this is probably something to look for when choosing a residency program, I'd guess some programs offer this while others don't.

AT&T commercial, I swear.

"These are perfectly good roll-over kills! When I was your age, we didn't even have these."

 

[teenmachinery1]

It never gets any easier. Watch this if you have the heart. It's like 50secs long.

http://www.youtube.com/watch?v=Nh-QOzHmr5s

 

[Terpskins99]

do you get roll-over kills?

like if you don't use one during your PGY-1 year, can you save it if you manage to kill 3 your PGY-2 year?


edit: this is probably something to look for when choosing a residency program, I'd guess some programs offer this while others don't.

 

[avksx]

There's some real **** going down in this thread. Every premed on the site needs to get in here.

 

[tkim]

There's some real **** going down in this thread. Every premed on the site needs to get in here.

Listen, this is stuff that as premeds, you should not be worrying about. Cart before the horse, as they say. The main objective at your stage of the game is to get into med school first. Worry about the freeps each program in each specialty offers after your clinical clerkships, when you start to think about residency. Plenty of time to consider this stuff later.

 

[smq123]

This definetly makes me feel more comfortable about it. However, I am still very shocked that they have a set number of people that can die under your care before you get in trouble..

Thanks for all your input...

I think that your FIRST priority at this point should be, before the MCAT or AMCAS, getting your sarcasm detector checked and refilling your common sense tank.

NO! Of course there is no set number of guilt-free kills you get. If you hurt a patient who is under your care, you will feel like complete and utter s/%!. If that is a risk you're not comfortable taking, then you shouldn't be a doctor. Lots of other healthcare careers let you take care of patients, with less chance of killing them.

 

[Sed8&Intub8]

I think that your FIRST priority at this point should be, before the MCAT or AMCAS, getting your sarcasm detector checked and refilling your common sense tank.

NO! Of course there is no set number of guilt-free kills you get. If you hurt a patient who is under your care, you will feel like complete and utter s/%!. If that is a risk you're not comfortable taking, then you shouldn't be a doctor. Lots of other healthcare careers let you take care of patients, with less chance of killing them.

Well it didn't make sense to me, and when I first read it I was like, yeah ok...but then people continued to speak about it and elaborate. So I thought that maybe there is something

 

[TooMuchResearch]

To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day. I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

Have you tried killing for fun? It may or may not be illegal depending on your country of residence; although, killing strangers in cold blood is probably frowned upon even if it's legal.

 

[TheMightySmiter]

Do you lose points for Opportunity KOs like in Smash Brothers?

 

[Bernoull]

2/year is only a guideline. Some inner city, county programs - lots of pathology, lots of non-compliant patients - lots of dead people. Some of those programs can only *dream* of keeping it at 2/yr. You won't find that stat on a program website.

Actually, some of the other residents joked about saving them up and using their 'free-passes' - "freeps" on patients they didn't like. Very poor taste and quickly got the hairy eyeball by the PD who happened to have overheard.

Wow, this reminds me of work in the pharmaceutical industry. My company only allowed us 2 OOS (Out Of Spec results/failed results) due to human error per year. One analyzes more than 6000 samples annually so 2 errors really isn't a bad error-rate, however everytime there's an OOS, it has to be investigated, root-cause analysis done, corrective action implemented etc etc and its take ~ 2-3 wks to investigate (its a pain for everyone involved). Basically, after ur 3rd OOS, you can start kissing goodbye to your yearly performance bonus 😡😡😡..

 

[bravofleet4]

This is a big fear of mine too. I don't know if I can make snap decisions or how fast I can respond to a sudden emergency. They say most deaths though occur during hand off, so I guess it's not during normal procedure but when there's an unusual interruption.

 

[IDoIt4Love]

To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day. I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

Aww...I'm sure all of us have worried about this at some point or another: good physicians tend to be caring and responsible in nature, so this isn't so surprising. This is how I look at it: it is possible that you will make a mistake. We're only human. But if you have always had nothing but good intentions and you always try your best to do the right thing, why would you blame yourself for an honest mistake? Think about all the people you have helped; all the lives you have saved, and realize that, in the end, you have done far more to keep your community healthy than harm them, and this is more than many folks can say.

 

[MedicalP]

You can't save everybody.

 

[FloatOn]

Fair enough. I may have been missing some sarcasm in first post b/c everyone dies, it is the ONLY thing guarenteed in life. The issue is whether the physician speed that eventuality up or not.

...and taxes!

OP, I think everyone in the healthcare profession, especially doctors, is scared of the same thing you are. Most people just try not to think about it or deal with it when it comes. Serious **** happens. You just have to do everything you can to try to prevent it, and know how to respond to the situation quickly and accurately. That's why so much education and training are required before you're off on your own.

 

[JackADeli]

You're allowed two clean kills per year in residency. Any more than that and you are subject to review.

do you get roll-over kills?...

2/year is only a guideline...

you get penalized if you do NOT use your allotted kills. They represent great learning moments lost. A resident that fails to fully use these limited opportunities is a "slacker". You only had two and you wasted them... Thus the rise around the end of the year in order to make sure you have no squandered the learning opportunities.

2/yr is definately just a guideline. It will very depending on any number of factors including population and geographic location. However, the most important factor reviewed is how much education each resident requires. A minimum of two but some clearly need more then 2/yr

 

[bamtuba]

you probably won't kill someone that wasn't going to die already...

Yeah, I think people took this the wrong way, but I don't think bleargh meant what some are implying.

I was once asked by a surgeon if I was dumb or stupid (for no particular reason mind you, he just wanted to discuss). In reply I asked, "what is the difference?"

"You're dumb when you don't know something but you're stupid when you don't know something and you refuse to admit it." In the context of the surgeries he commonly performs he continued, "don't be stupid, it gets people killed."

Just use common sense and take your training seriously. Don't be the kid who "always has the answers" when you don't. Let the rest worry about itself and hopefully you'll do the best you can when the time comes.

 

[amine2086]

To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day. I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

I think it is natural to think of the possible negative consequences of our actions. True, you may make a mistake that might cause someone to die or worsen someone's condition, but I think of it from the prospective of "glass half full." Think about all the diseases you may be curing, or the lives you may be saving. If you do your best, you should have no regret.

 

[Sed8&Intub8]

Aww...I'm sure all of us have worried about this at some point or another: good physicians tend to be caring and responsible in nature, so this isn't so surprising. This is how I look at it: it is possible that you will make a mistake. We're only human. But if you have always had nothing but good intentions and you always try your best to do the right thing, why would you blame yourself for an honest mistake? Think about all the people you have helped; all the lives you have saved, and realize that, in the end, you have done far more to keep your community healthy than harm them, and this is more than many folks can say.

Good Point! 🙂

 

[NickNaylor]

So are you allowed two freebies or not?

 

[mediterranean]

So are you allowed two freebies or not?

I don't think you should ask. It is definitely not a freebie because a whole board of attending and authorities pull together and have to discuss what went wrong and if you treat them like freebies then everyone will give you a dirty look. Although no names are mentioned, if you don't feel apologetic and responsible, everyone will treat you quite the opposite.

 

[Narmerguy]

I think the number of deaths the hospital will endure before intervening will vary by hospital/specialty. Either way, I think it's clear that no one walks away from being responsible for a patient's death without being affected emotionally (unless you're a freaking monster).

 

[boostedct9a]

To Med students and physicians,

I am hoping to go to med school in the new few years, but one fear that I am having a really time getting over is that fact that I might kill a patient on day. I might make a mistake, miss something important, make a bad judgement call, which causes him/her to die.

Have any of you folks felt this way, because this has made me go paranoid for years. And if so, how did you get over that fear? Thanks.

I used to be afraid of the same thing. It probably isn't the best idea but I studied forensic pathology through the Southern Institute of Forensic Science. Seeing everything that I saw desensitized me to the point where nothing shocks me and I have actually somehow lost the fear of accidentally killing someone. Now I'm more scared of what the repercussions might be in court. I think that in the long run it will help me keep my sainity and become a better surgeon.

 

[JackADeli]

So are you allowed two freebies or not?

Technically it's not free... cause they still have to pay you (or their insurance). So it's a paid for kill.

I think the number of deaths the hospital will endure before intervening will vary by hospital/specialty...

True. It comes down to how "clean a kill" it was... The muddier the waters the more you can walk away from it. If it's clear cut, "clean kill" from point "a" to "b" you have more difficulty....:cry:

....desensitized me to the point where nothing shocks me and I have actually somehow lost the fear of accidentally killing someone. ...I think that in the long run it will help me ... become a better surgeon.

Frightening... not likely to help you become a better surgeon. I would strongly encourage folks intent on a medical career to focus on getting into medical school first. While in medical school let your natural fear or desire to be the best for your patient drive you to learn as much as you can...

Do NOT, I repeat, do NOT engage in desensitizing exercises.....