Mistakes

[deleted836128]

I feel like we don’t often talk about mistakes we make on the job. Makes me cringe to think about making a mistake... but I guess it happens to all of us from time to time.

What was a memorable mistake that you made? Was it a “close call” or did it result in harm to the patient? What did you learn from it? Are there any mistakes that you’ve made repeatedly?

I think we should talk about this stuff more often.

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[gutonc]

You first.

 

[NYEMMED]

The reason we don’t talk about them much is mistakes can lead to lawsuits years later.
Anything you disclose publicly can be used against you

 

[RustedFox]

I was one year out of residency.
I put in a chest tube and sliced an intercostal artery. Had to have the surgeon bail me out, which he totally graciously did.
Guy was in his 90s and was going to die no matter what we did or didn't do.
I will forever owe that surgeon a debt of gratitude.

Funny part of it all was; the family actually called me to say "thanks for caring for our family member during his last days". I didn't expect that at all.

I have caused exactly one pneumothorax when putting in a central line (I was a resident). I can't imagine ever doing it again, but it will happen given enough central lines.

 

[OneTwoThreeFour]

Almost did a lac repair without stopping for a time out. Thank god the nurse stopped me.

 

[Birdstrike]

The reason we don’t talk about them much is mistakes can lead to lawsuits years later.
Anything you disclose publicly can be used against you

agree. SDN is a tough plan to talk about perceived mistakes. Among close friends, across a table over a delicious beverage is the more appropriate place. But to get people to post that publicly in the days of non-anonymity, is a tough sell.

 

[gro2001]

I feel like we don’t often talk about mistakes we make on the job. Makes me cringe to think about making a mistake... but I guess it happens to all of us from time to time.

What was a memorable mistake that you made? Was it a “close call” or did it result in harm to the patient? What did you learn from it? Are there any mistakes that you’ve made repeatedly?

I think we should talk about this stuff more often.

When I was an intern one of our chiefs used the last morning report he had to give to talk about his mistakes over the course of residency. I thought that was pretty cool, and when I was giving my last morning report, I also talked about all my mistakes and what I learned from them. It's a pretty hard thing to do without getting defensive, even in the circle of trust. Harder still in some ways here.

When I started replying to your post, I was initially planning to post in some detail on what mistakes I talked about. On second thought I don't feel comfortable doing that. But I can give you the general outline:

-intern year mistake with fluids and ins/outs of a patient that led to a pretty significant electrolyte abnormality
-forgetting to give someone a medication that led to a minor complication
-a procedural mistake due to unusual patient factors that was a near miss
-several communication related issues (sometimes arguing about something unnecessarily, sometimes not speaking up when I should have)
-not respecting how sensitive old people can be to dose changes
-giving tPA to someone I shouldn't have
-an issue related to signing out a complex patient
-focusing on the resuscitation of a dying patient at the expense of comforting the family

Not all of these were necessarily avoidable but all were major learning points for me.

 

[Rendar5]

Not necessarily mine (disclaimer and all that and intentionally vague to protect against lawyers) but these come to mind.

Giving heparin to someone with a decently large stroke to treat the untreated a fib.
Misclicking and thinking antibiotics were ordered and didn’t actually order them. (Patient didn’t get them until the next morning 12 hours later).
Not seeing an incidental lab abnormality and discharging the patient home.

 

[TooMuchResearch]

This is better. Let's talk about other people's mistakes. I'll come up with some later.

Not necessarily mine (disclaimer and all that and intentionally vague to protect against lawyers) but these come to mind.

Giving heparin to someone with a decently large stroke to treat the untreated a fib.
Misclicking and thinking antibiotics were ordered and didn’t actually order them. (Patient didn’t get them until the next morning 12 hours later).
Not seeing an incidental lab abnormality and discharging the patient home.

 

[CajunMedic]

Not necessarily mine (disclaimer and all that and intentionally vague to protect against lawyers) but these come to mind.

- Forgot to input orders in on an ICU patient that came up at shift change, and didn't give a good sign out to the night team. Could have had a bad outcome but ER Senior Resident happened to log in from home to follow up and catch it

- Went with critical pt to CT, enroute to floor from ICU, left patient to fill in Seniors on newly found bilateral basal ganglia bleed, by the time they got to the ICU, pt. had went apneic and ED came up to intubate.

-Diagnosis anchored on a chest pain patient, didn't do a good abdominal exam, Negative troponin and EKG, but 3300 Lipase. Attending caught it pretty quickly.-got a much better Hx. Admitted for Pancreatitis

 

[thegenius]

When I was an intern one of our chiefs used the last morning report he had to give to talk about his mistakes over the course of residency. I thought that was pretty cool, and when I was giving my last morning report, I also talked about all my mistakes and what I learned from them. It's a pretty hard thing to do without getting defensive, even in the circle of trust. Harder still in some ways here.

When I started replying to your post, I was initially planning to post in some detail on what mistakes I talked about. On second thought I don't feel comfortable doing that. But I can give you the general outline:

-intern year mistake with fluids and ins/outs of a patient that led to a pretty significant electrolyte abnormality
-forgetting to give someone a medication that led to a minor complication
-a procedural mistake due to unusual patient factors that was a near miss
-several communication related issues (sometimes arguing about something unnecessarily, sometimes not speaking up when I should have)
-not respecting how sensitive old people can be to dose changes
-giving tPA to someone I shouldn't have
-an issue related to signing out a complex patient
-focusing on the resuscitation of a dying patient at the expense of comforting the family

Not all of these were necessarily avoidable but all were major learning points for me.

If I recall gro, didn’t you need 3or 4 morning reports to go over all your mistakes?

(Edit: we went to the same residency program)

 

[deleted836128]

I have recently made the mistake of admitting an older lady for diverticulitis due to failure of outpatient treatment ... when she didn’t actually have it. The hospitalist called me and was like “Why are you admitting this patient? She was already admitted last week and her CT is fine.” I looked at the CT report and noted that it said “RESOLVING diverticulitis.” No one was harmed obviously, but it was embarrassing to have to go back in and tell the patient what happened.

A few weeks ago I had an old lady with back and pelvic pain who couldn’t walk due to pain. We were having issues with CT reports not crossing over into the system so I called radiology and asked what was found and they said a sacral fracture. Little did I know they had only looked at the lumbar CT. So I told the lady and her family what we found...the lady was in the hospital NINE HOURS while waiting to go to a SNF. Minutes before transport arrived I am going through her chart and the pelvic CT pops up and shows a bunch of fractures. Luckily it didn’t change management, it was not an unstable and still not surgical, but it was embarrassing to have to go back in and tell the patient after she’d already been there nine hours.

I have once or twice missed lab abnormalities like low potassium, or incidental findings on radiology reports, and then have to frantically try to call the patient and let them know.

Once I missed a cervix laceration. A lady came in with vaginal bleeding after an IUD. I did a pelvic and noted very heavy bleeding with clots but did not visualize a source. The ultrasound was fine. I called GYN and they said it sounded like she was just having a period. I told the patient that but I decided to do a pelvic again and at this point the patient was at just the right angle and I saw a TINY paper cut like laceration maybe a half centimeter long that was just trickling blood. Two vials of Monsel’s did the job, thank goodness.

Dumb stuff like this. I’ve only been in emergency medicine three and a half years so I haven’t yet made a terrible mistake but I know my day will come and I honestly worry about how I am going to deal with it.

 

[deleted836128]

Here’s a bad one that was a NEAR miss or a good catch, however you want to frame it. The patient still died but I will never forget this one.

[insert story about near miss subarachnoid hemorrhage here - deleted ]

 

[RustedFox]

Here’s a bad one that was a NEAR miss or a good catch, however you want to frame it. The patient still died but I will never forget this one.

[insert story about near miss subarachnoid hemorrhage here - deleted ]

Dude.
That sucks.

You're not alone.

 

[deleted836128]

Dude.
That sucks.

You're not alone.

Thanks, RustedFox.

 

[Groove]

We really need a private sub-forum for threads like this one. One that's not open to the public.

 

[Listen2Savage]

saw a PA-C present a 32 F as shingles today

granted the vesicles were in a unilateral L2 dermatome

but... they were more purulent, small with central induration type shiz like folliculitis or something, 10 or so with a wide base of erythema, was leaning more towards staph or posion ivy ...

Idk... she came up and was like hey look at this slam dunk shingles dx and I was like ...ok how old is she/he... 32 ?

yeah idk

maybe these forums have me doubting our PA brethren

 

[Janders]

(I mean I've seen a ton of shingles in people in their 20s/30s...)

 

[GeneralVeers]

saw a PA-C present a 32 F as shingles today

granted the vesicles were in a unilateral L2 dermatome

but... they were more purulent, small with central induration type shiz like folliculitis or something, 10 or so with a wide base of erythema, was leaning more towards staph or posion ivy ...

Idk... she came up and was like hey look at this slam dunk shingles dx and I was like ...ok how old is she/he... 32 ?

yeah idk

maybe these forums have me doubting our PA brethren

Sounds like shingles. Otherwise non-toxic? Can DC home. Shingles rash can look like vesicles, red spots, ulcers, pustules, or not even have a rash and just pain.

 

[Listen2Savage]

Sounds like shingles. Otherwise non-toxic? Can DC home. Shingles rash can look like vesicles, red spots, ulcers, pustules, or not even have a rash and just pain.

ya, Im not hating on the PA

When Ive seen slam dunk shingles tho they've been the"dewy rose petal" vesicles, not pustular

 

[deleted836128]

We really need a private sub-forum for threads like this one. One that's not open to the public.

Yeah. I should probably delete my story.

 

[NYEMMED]

Yeah. I should probably delete my story.

Unfortunately yes. Great story, though.

Unless you are outside the statute of limitations for your state...

 

[deleted109597]

We really need a private sub-forum for threads like this one. One that's not open to the public.

We have one called the practicing physicians forum. It's not secret or anything, but it isn't publicly accessible.

 

[gro2001]

If I recall gro, didn’t you need 3or 4 morning reports to go over all your mistakes?

(Edit: we went to the same residency program)

Only because half of them had the phrase "but then I listened to thegenius, and..."

 

[Groove]

We have one called the practicing physicians forum. It's not secret or anything, but it isn't publicly accessible.

I meant one specific to the EM forum, similar to the Anesthesiology forum... If we had one open to attendings and residents only, etc.. people would probably feel a lot more comfortable sharing about certain topics. Just an idea.

 

[Groove]

The irony is that we all make mistakes. That's what makes us human. We just aren't able to talk about them with anyone very easily d/t all the reasons listed above. Therefore we all walk around acting like we never make mistakes thereby making other physicians feel like they are incompetent when they do make mistakes. It's a vicious cycle.

On a related note, I subscribe to Risk Management monthly and one of their topics for June was on this study by Stanford Law Review. The consensus was :

-Apology laws don't work
-Apologies alert pt's to potential malpractice claims
-You are more likely to be sued if you apologize for a mistake

Another article on the same topic.

 

[NYEMMED]

The irony is that we all make mistakes. That's what makes us human. We just aren't able to talk about them with anyone very easily d/t all the reasons listed above. Therefore we all walk around acting like we never make mistakes thereby making other physicians feel like they are incompetent when they do make mistakes. It's a vicious cycle.

On a related note, I subscribe to Risk Management monthly and one of their topics for June was on this study by Stanford Law Review. The consensus was :

-Apology laws don't work
-Apologies alert pt's to potential malpractice claims
-You are more likely to be sued if you apologize for a mistake

Another article on the same topic.

I think you sparked some interest in me subscribing to RMM

 

[gro2001]

I think you sparked some interest in me subscribing to RMM

What's RMM?

 

[TooMuchResearch]

Risk Management Monthly.
I just subscribed.

What's RMM?

 

[Groove]

Risk Management Monthly.
I just subscribed.

It's a little pricey but there really aren't too many other competitors. Plus, I like Rick Bukata. I typically will skim the monthly synopsis on the website and listen to parts of the podcast that are related to what I'm interested in... Plus, you can search all the previous editions for key words if you are interested in a particular topic.

There are a few podcasts on youtube if anyone wants to get a flavor:

 

[southerndoc]

I used to subscribe to this but gave it up due to too many podcasts (RMM, EM:RAP, PEC, etc.).

 

[suckstobeme]

I used to subscribe to this but gave it up due to too many podcasts (RMM, EM:RAP, PEC, etc.).

PEC?

 

[Old_Mil]

I feel like we don’t often talk about mistakes we make on the job. Makes me cringe to think about making a mistake... but I guess it happens to all of us from time to time.

What was a memorable mistake that you made? Was it a “close call” or did it result in harm to the patient? What did you learn from it? Are there any mistakes that you’ve made repeatedly?

I think we should talk about this stuff more often.

One of the reasons I like being on the peer review committee is I can learn from the mistakes of others and don't have to make them all myself. I'd really recommend any younger physicians coming out of residency try to get on their hospital's peer review committee.

 

[Apollyon]

One of the reasons I like being on the peer review committee is I can learn from the mistakes of others and don't have to make them all myself. I'd really recommend any younger physicians coming out of residency try to get on their hospital's peer review committee.

Didn't you get completely out of medicine, with some similar paying job in Canada, or do I have you confused when someone else?

 

[bravotwozero]

I believe he sells shower caps to hotels...I second the peer review committee thing. I am on one myself and it’s a great learning experience, though the majority of cases end up being surgical complications. You also get to defend your colleagues.

 

[Merely]

You guys seem paranoid af..as long as you’re not posting your name and practice location..lawyers aren’t going to come to this board to try to find you and use that in a case against you..that’s never been done ever

 

[TooMuchResearch]

Our group sends out learning points from all peer review quarterly. It's like being on peer review, but without the meetings.

One of the reasons I like being on the peer review committee is I can learn from the mistakes of others and don't have to make them all myself. I'd really recommend any younger physicians coming out of residency try to get on their hospital's peer review committee.

 

[gro2001]

You guys seem paranoid af..as long as you’re not posting your name and practice location..lawyers aren’t going to come to this board to try to find you and use that in a case against you..that’s never been done ever

I don't think that's most people's concern exactly. I agree, that would be far fetched. However, if there is some unrelated trouble, I'd think it would be more plausible that someone (like a plaintiff's lawyer) does some digging for extra ammunition to throw at you.

 

[Merely]

I don't think that's most people's concern exactly. I agree, that would be far fetched. However, if there is some unrelated trouble, I'd think it would be more plausible that someone (like a plaintiff's lawyer) does some digging for extra ammunition to throw at you.

That’s never been done befor...again as long as you’re somewhat anonymous no one has the time to randomly go on one of a several online medical forums to try to determine which poster you are then try to use that against you..lawyers have to be efficient in their time not randomly surf the internet

 

[Groove]

Peer review...heh, man you guys think WE make some mistakes in the ED, you should hear some of the stuff in Peer review from docs in the hospital within other specialties. CRAZY.

Edit: Example case removed, as I probably shouldn't be sharing that one.

 

[deleted497653]

I don't think that's most people's concern exactly. I agree, that would be far fetched. However, if there is some unrelated trouble, I'd think it would be more plausible that someone (like a plaintiff's lawyer) does some digging for extra ammunition to throw at you.

I don't think that's most people's concern exactly. I agree, that would be far fetched. However, if there is some unrelated trouble, I'd think it would be more plausible that someone (like a plaintiff's lawyer) does some digging for extra ammunition to throw at you.

Agree. Maybe I’ve been watching too many law tv shows but it seems most cases are circumstantial and based on random information a lawyer or investigator dug up[/QUOTE]