What would you regret most as a Doc?

[ePiCuReAn DaVc]

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This is something that keeps coming back to haunt me now and then...so let me use the anonymity of the forum to ask some "peers" what they got to say about this!!! 🙁 . When I was an Intern, there was a 'DIABETIC' patient who underwent elective Herniorapphy in 2nd POD for whom I 'forgot' to write the orders for bedtime insulin! 🙁 🙁 🙁

And as Murphy loves saying
"If something can go wrong, it will go wrong". And heavens it did...The patient suffered a post-op MI!. Was it that the lack of insulin for the 2 days that resulted in this?

As medical students/ interns or residents have you had any such bad experiences?

We all know medical errors are very common, but has it happened in your life that makes you rue about it?...

 

[Nick99]

I think that most of doc's mistakes are understandable. It goes along with everyday practice. Doctors are just human beings too and they are not perfect as some people might think icluding some doctors too. The thing that is not understandable is when some doctor do mistakes intentionaly or being neglectful because they beleive that some patiens do not deserve proper care like old people, low class people, different race people etc.. and this thing is not that uncommon at all.

 

[Lemont]

I think a doctor's biggest regret would be to one day end up like these one of unfortunate doctors:

http://www.cpmission.com/main/charged.html

Some of the stories are real tragic, especially Dr. Benjamin Moore.

 

[ePiCuReAn DaVc]

I think a doctor's biggest regret would be to one day end up like these one of unfortunate doctors:

http://www.cpmission.com/main/charged.html

Some of the stories are real tragic, especially Dr. Benjamin Moore.

I think I gotta agree...that should be one ****hole u dont want to be near of!

Screw the Lawyers! 😡 😡 😡

 

[Blade28]

*knock on wood* no disasters yet, but definitely the occasional mistake which doesn't get caught until a couple days later. Thankfully, the patients have all ended up OK - no morbidity, no presenting at M&Ms. 🙂

 

[residentx2]

I doubt seriously that lack of insulin for 2 days caused his MI. It was going to happen anyway. A high blood sugar for 2 days did not cause the clot that caused his MI. More likely it was years of smoking, fatty foods, obesity and noncompliance that caused it. Don't be so hard on yourself. You did not cause it nor could you have prevented it.

 

[lexrageorge]

I doubt seriously that lack of insulin for 2 days caused his MI. It was going to happen anyway. A high blood sugar for 2 days did not cause the clot that caused his MI. More likely it was years of smoking, fatty foods, obesity and noncompliance that caused it. Don't be so hard on yourself. You did not cause it nor could you have prevented it.

I agree 100% that this was not the intern's fault. However, don't assume that it was the patient's fault. I knew someone who watched his diet very carefully, exercised regularly, and was in excellent physical shape. He dropped dead of a sudden, massive MI at 46. There is an element of randomness (or luck) that cannot nor should not be ignored.

FWIW, I for one do not believe in the media hysteria that medical "errors" cause 100,000+ deaths anually. Most of these patients in these studies were very frail with a host of medical problems, and required multiple medications and procedures just to survive the day. Most would have died within a couple of days even without the "error".

 

[DOtobe]

On one of my surgery calls last month, I gave a patient 1 mg of morphine who was post-op and having a lot of pain. About an hour and a half later I hear "code yellow" (which is sort of a pre-code blue in my hospital), and it was that patient. Never mind the patient has horrible lungs and many other health problems, but I kept thinking my 1 mg of morphine was what put him into respiratory distress. He didn't respond much to Narcan, so it probably wasn't my fault, but I couldn't help but feeling guilty about giving him morphine. He has been fine since then (other than still having awful lungs), but I still feel bad about it. Nothing else since then, though 👍

 

[OldPsychDoc]

Suicide by overdose---my name on the pill bottle. 🙁

 

[ePiCuReAn DaVc]

On one of my surgery calls last month, I gave a patient 1 mg of morphine who was post-op and having a lot of pain. About an hour and a half later I hear "code yellow" (which is sort of a pre-code blue in my hospital), and it was that patient. Never mind the patient has horrible lungs and many other health problems, but I kept thinking my 1 mg of morphine was what put him into respiratory distress. He didn't respond much to Narcan, so it probably wasn't my fault, but I couldn't help but feeling guilty about giving him morphine. He has been fine since then (other than still having awful lungs), but I still feel bad about it. Nothing else since then, though 👍

I agree fully..thats one of the bad things about Medicine...

You commit an error....things turn out bad....

You feel guilty....and then we tend to use rationalisaton as a Freudian defense against our error!

Thats where I get caught...what is the truth....how do I know if the morphine caused the distress (eventhough it didnt respond to Narcan)....how do I know if the missed Insulin had anything to do with the MI?

Oh God!, Did I choose the right career?

 

[ePiCuReAn DaVc]

I agree 100% that this was not the intern's fault. However, don't assume that it was the patient's fault. I knew someone who watched his diet very carefully, exercised regularly, and was in excellent physical shape. He dropped dead of a sudden, massive MI at 46. There is an element of randomness (or luck) that cannot nor should not be ignored.

FWIW, I for one do not believe in the media hysteria that medical "errors" cause 100,000+ deaths anually. Most of these patients in these studies were very frail with a host of medical problems, and required multiple medications and procedures just to survive the day. Most would have died within a couple of days even without the "error".

Havent you come across a few 'serious' medical errors by interns/ residents and other housestaff?

I believe it is quite common! (maybe I want to believe coz I did one major one... 🙁 🙁 )....

 

[docB]

Suicide by overdose---my name on the pill bottle. 🙁

That's a tough one. It happens to all of us though. In EM it always begins with the phrase "Remember that patient...?" There are no certainties. We are all dealing with sick people be it heart disease or depression. Ultimately the decision about what to do is a judgement call and we're not infallable. You can do everything right and people will still die. The lawyers understand this but they make money off of telling juries that medicine is a 100% rock hard science with more absolutes than uncertainties. Schmucks.

 

[MDgonnabe]

Suicide by overdose---my name on the pill bottle. 🙁

oh man. 🙁 that totally sucks. i can't wait until my first patient suicide happens. i wonder if i'll even hear about it. i know it's only a matter of time that any given doctor, no matter how good, makes a "mistake." but i think the consistent thing that's been pointed out here is that were it not for doctors, all of these people would've died from one reason or another much sooner rather than later. in that regard, we've done no harm. if a patient wants to kill themselves, there's ultimately nothing you can do to stop them short of physically restraining them 24-7 somehow (and that's only if you get a warning of any sort, which seldom happens with someone who's serious about it). if a patient dies of an mi because they haven't been compliant with their lipid lowering meds or they never took their doctor's advice to change their diet or exercise more, well, again, you can't live that patient's life. they did what they wanted and there's simply no way to undo decades of damage in a few days within a hospital... in the long run, though, i'm sure we save far more lives than we'd ever know because the main things we'll hear about are these m&m's.

 

[beezar]

On one of my surgery calls last month, I gave a patient 1 mg of morphine who was post-op and having a lot of pain. About an hour and a half later I hear "code yellow" (which is sort of a pre-code blue in my hospital), and it was that patient. Never mind the patient has horrible lungs and many other health problems, but I kept thinking my 1 mg of morphine was what put him into respiratory distress. He didn't respond much to Narcan, so it probably wasn't my fault, but I couldn't help but feeling guilty about giving him morphine. He has been fine since then (other than still having awful lungs), but I still feel bad about it. Nothing else since then, though 👍

1 mg of morphine in a patient who truly has a lot of pain is like water... practically nothing (unless he/she is a peds pt)... I've easily given 10mg+ morphine IV to an opiate naive pt over 10-20 mins postop. And if opiates are to blame for respiratory problems, they are almost always because the pt stops breathing rather than having respiratory distress.

Anyway, as an intern, I'm sure I had a heavy hand in contributing to a pt's death as I had given too much fluid to a pt who went into respiratory failure and died overnight. Granted, he had an albumin of < 1, probably should have been in the unit to begin with but was DNR/DNI, and intubation would have saved him, but still makes you feel like total crap... actually thought about quitting medicine that day. But it gets better with time, and you have to remember that.

 

[ePiCuReAn DaVc]

But it gets better with time, and you have to remember that.

Truly agreed!

It really gets better with time!

You tend to forget those mistakes and focus on something else....For instance there was one Intern who was a pretty good student who tried to pass a NGT and ended up trying to asphyxiate the patient!

It does wonders to your confidence, doesnt it? 😉

 

[doc05]

This is something that keeps coming back to haunt me now and then...so let me use the anonymity of the forum to ask some "peers" what they got to say about this!!! 🙁 . When I was an Intern, there was a 'DIABETIC' patient who underwent elective Herniorapphy in 2nd POD for whom I 'forgot' to write the orders for bedtime insulin! 🙁 🙁 🙁

And as Murphy loves saying
"If something can go wrong, it will go wrong". And heavens it did...The patient suffered a post-op MI!. Was it that the lack of insulin for the 2 days that resulted in this?

As medical students/ interns or residents have you had any such bad experiences?

We all know medical errors are very common, but has it happened in your life that makes you rue about it?...

why was an elective herniorraphy still in the hospital on POD2??

 

[Blade28]

Suicide by overdose---my name on the pill bottle. 🙁

Ouch, that's pretty rough.

I agree fully..thats one of the bad things about Medicine...

You commit an error....things turn out bad....

You feel guilty....and then we tend to use rationalisaton as a Freudian defense against our error!

And if you're in surgery, then you get the pleasure of a thorough roasting during the weekly M&M conference. 🙁

 

[margaritaboy]

On one of my surgery calls last month, I gave a patient 1 mg of morphine who was post-op and having a lot of pain. About an hour and a half later I hear "code yellow" (which is sort of a pre-code blue in my hospital), and it was that patient. Never mind the patient has horrible lungs and many other health problems, but I kept thinking my 1 mg of morphine was what put him into respiratory distress. He didn't respond much to Narcan, so it probably wasn't my fault, but I couldn't help but feeling guilty about giving him morphine. He has been fine since then (other than still having awful lungs), but I still feel bad about it. Nothing else since then, though 👍

I would agree with another poster above. Unless your patient was an infant, 1 mg of morphine is a hopelessly small dose to alleviate pain, let alone cause respitory arrest.

Remember that the dosing for morphine is .1mg/kg. Thats 10mg IV for a 100kg patient.

 

[MD'05]

1 mg of morphine in a patient who truly has a lot of pain is like water... practically nothing (unless he/she is a peds pt)... I've easily given 10mg+ morphine IV to an opiate naive pt over 10-20 mins postop. And if opiates are to blame for respiratory problems, they are almost always because the pt stops breathing rather than having respiratory distress.

Anyway, as an intern, I'm sure I had a heavy hand in contributing to a pt's death as I had given too much fluid to a pt who went into respiratory failure and died overnight. Granted, he had an albumin of < 1, probably should have been in the unit to begin with but was DNR/DNI, and intubation would have saved him, but still makes you feel like total crap... actually thought about quitting medicine that day. But it gets better with time, and you have to remember that.

I agree with everyone else. 1 mg of morphine won't kill an adult and I always start with 1 mg to be sure there is no "allergic" reaction such as hallucinations etc.

I think death by normal saline is pretty common. What are you going to do? You try to keep blood pressure up and get good urine output with fluids and give lasix to prevent pulmonary edema. And if the person is DNR or chemical code only (which is ludicrous) it's a no-win situation. And if the person isn't even in the ICU when they need to be, oh well.

 

[DOtobe]

I would agree with another poster above. Unless your patient was an infant, 1 mg of morphine is a hopelessly small dose to alleviate pain, let alone cause respitory arrest.

Remember that the dosing for morphine is .1mg/kg. Thats 10mg IV for a 100kg patient.

Thanks for making me feel better! I figured the morphine probably wouldn't do it, but I just couldn't shake the thought that maybe it had. Every call on surgery I was afraid of doing something stupid, since I'm not a surgeon...Good to be back on family practice call now. 🙂

 

[alina_s]

I just had a patient die of bacteremia/pneumonia. He had 101 other yet-to-be identified ailments but I can't help wondering if he might somehow have made it if I had argued harder to start antibiotics sooner. He'd started coughing up phlegm but stayed afebrile- since he couldn't swallow, we attributed the cough to that at first. Then when he started spiking fevers, ID didn't want to treat without a known source of infection. By the time we started to treat, it was too late. To make it worse, the morning before he died one of the consultants chastized me for not staying up to see his CXR, even though we had him on antibiotic coverage for everything and he didn't want any surgical intervention. As if my seeing that film 2 hours earlier could have changed anything- the change in treatment after the Xray was stopping the antibiotics and going to comfort care only. I still felt awful.
When he first came in, he was a really difficult patient, didn't want to tell us anything, and I couldn't tell if he was just bitter about being so sick or if he really didn't want to be treated at all and wanted to die (he'd been brought in by family against his will and he was young to be DNR/DNI). But did my pessimism about his condition affect the way I presented his problems to my attending and how much I was willing to argue for treatment?

 

[ePiCuReAn DaVc]

Hey Alina,

If u remember, I started the thread.

As usual, SDN has taught me so much....

1. Outcome in Medicine is multi-factorial...so whether a particular Patient responds to a particular treatment, you can never know.

2. This does not mean that outcome of medicine is not related to quality of care, It defintely is. So providing Evidence based quality healthcare must be your foremost aim. 🙂 🙂 🙂

3. Staying up to see the CXR, not showing optimism may not have changed the outcome, but they point towards your 'interest' in caring for the patient. 🙁 🙁 🙁

Hope this helps
Learn from your experience 😉


P.S: The Patient was in the hospital on 2nd POD due to post-anesthetic complications.

 

[ePiCuReAn DaVc]

Hey Alina,

If u remember, I started the thread.

As usual, SDN has taught me so much....

1. Outcome in Medicine is multi-factorial...so whether a particular Patient responds to a particular treatment, you can never know.

2. This does not mean that outcome of medicine is not related to quality of care, It defintely is. So providing Evidence based quality healthcare must be your foremost aim. 🙂 🙂 🙂

3. Staying up to see the CXR, not showing optimism may not have changed the outcome, but they point towards your 'interest' in caring for the patient. 🙁 🙁 🙁

Hope this helps
Learn from your experience 😉


P.S: The Patient was in the hospital on 2nd POD due to post-anesthetic complications.