>In his effort to understand hospital safety and risk, he learned these oft-cited projections: more than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week, Terblanche calculated.
This reminds me of the book The Checklist Manifesto by surgeon Atul Gawande. The book argues that aviation has achieved such a good safety record largely through the use of checklists, and Gawande describes his attempts to apply them to the field of medicine. Recommended. (Edit: I see that checklists are discussed later in the article; I would still recommend the book, as it has thoughts on how checklists can be applied more effectively.)
If you read the complete article it specifically mentions that Sam's condition did trigger some checklists, but those checklists were willfully ignored in favor of expediency.
The problem isn't that there's not enough checklists, the problem is that there's one pilot and he's trying to fly 3 Boeings at the same time from the air traffic control tower.
> These unreliable warnings can lead to “alert fatigue” and, sometimes, a mental habit of discounting them.
This is a problem the airline industry also struggles with and even more checklists is not the answer. A lower workload and better crew resource management is.
I think it's more like Sam's condition did not clearly fit into a checklistable entity. Our heart rate and temperature go up when we have the flu, but we don't all go in to hospital for antibiotics or die at home. Probably they should have done more work-up the second time he came in but as the article points out that could also have been negative. He was probably just too young for checklists built for older people to pick up on his condition.
Being a pilot I can attest how important checklists are, and I do advocate for using them in medicine (have practicing relatives, and I have them tired with that).
But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?)
There are some other 100s of reasons why aviation is safe. Heck, some of them could also be applied NOW: people must rest! I do NOT want to be treated by a doctor doing an idiotic 24hs shift, which is the norm in every country I know of…
There is a whole list of things that can be transferred from aviation to medicine.
Another point I know of is the “handover” of patients. Just as ATC hands over planes from one controller to another, some procedure should warrant the correct transfer of information between shifts. Oh boy I have hear some funny (and some bot at all funny) stories about it.
The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever.
Which is why the staff is stretched thin, as a rule and not as an exception.
Not that there's a shortage of other issues that compound that. But even if those issues weren't a thing? The curse is far too strong.
this is vastly complex than aviation. it is like 10 pilots and co-pilots trying to fly 100 planes and simultaneously switching between them. and with everyone overworked due to no mandated breaks.
no amount of checklist would prevent mistakes. we need legislation to limit medical workload, which is unlikely due to the shortages.
FTA: "As hard as the job is, diagnostic accuracy in the E.R. is high overall. But a recent systematic review of published research estimated that 5.7 percent of E.R. patients will have at least one diagnostic error and 2 percent have a setback as a result."
I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care.
2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes.
Costly healthcare due to scrutiny is not the problem with healthcare in the US. The problem is drug monopolies, medical (mal)practice without a license by insurance companies, and the lack of taxpayer funded healthcare-as-a-right.
We need to create an environment where someone like Terblanche feels comfortable advocating for himself without feeling like he's being a burden on the ER, and physicians don't feel like they're wasting time by investigating seemingly trivial cases. Such a situation exists because we are not pouring enough money into healthcare in this country.
It feels high to me because most ER cases should be obvious i.e. heart attacks, car accidents and strokes etc. So if say 10% of cases are non standard then 2% overall is 20% off that.
We don't have an anti-heart attack pill. Medicine hasn't developed the post-car-accident protocol. Strokes vary so much in type that they can go unrecognized by competent doctors for years.
> 2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes
There will be rapid diminishing returns. It may cost 5x to get to 1-2%. Maybe 10x.
An alternative way to throw money at the problem: Instead of trying to further improve accuracy, build out space for more ER beds, and implement continuous monitoring of marginal patients.
Or, build devices to send home with patients which allow for cheap, continuous self-monitoring. That might be a legitimate application of AI actually, if you could use e.g. phone camera tricks to measure more health parameters. Even if imperfect, it could still pick up a few patients who should not have been sent home.
This is mentioned in the article, the fundamental problem is a capacity problem. If patients could be moved out of the ER department to hospital wards then there would be a greater ability for the ER department to monitor patients.
> I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care.
If only. Then the outcomes would be better.
The real reason is that it's ostensibly supposed to be a market but the pricing for everything is completely opaque and shrouded in bureaucracy and corruption.
> I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care
All research I’ve read on this topic finds that it is the US legal system that causes the crazy prices (incentivizing more testing to cover-your-ass and avoid liability etc.)
Many comparative studies on health care cost and quality use the US military as a proxy, as it is free on the condition that you cannot litigate (very coarsely; it is more nuanced).
The costs for treating US military personel is much closer to other countries (while treatment quality remains equal).
It´s not just the legal system. A lot of US Doctors are typically paid on a piece rate basis, and the medical records systems are extremely fragmented, so there is an incentive to order repeat tests (as you get passed around from specialist to specialist), and no incentive to put the systems in to make that unnecessary.
We expect so much from our health care providers, and we sometimes don't appreciate that they deal with a wide array of patients.
Some will come in with a tiny brushing, asking if they are going to die. Others will walk around with a critical condition for days, saying maybe they were a little sore, but they didn't think it was too bad.
We might need other measures. It might be damn complex. Ideally 100% would die from "malpractice" (or unknown
able issues) because people are so healthy and society is so safe there is barely anyone in ER.
Part of the reason is - people are not machines, its extremely hard to diagnose quite a few situations since every body is a bit unique. Add tons of medications and issues every older person has, within their own unique bodies. Add symptoms like chest or abdominal or head pain which can mean hundreds of conditions, some benign some deadly. Add time pressure to diagnose quickly since that's how medical systems are set up. Wife is a doctor so I can see the perspective from the other side too.
I've had a thrombosis formed in my calf after having a broken leg and using cast. I also caught covid during that time, and from what I've read now I believe it increases temporarily clotting of blood for certain people. When cast was removed, leg was still stiff as wooden plank and ankle didn't bend. I wasn't told to keep the leg higher so I didn't. Some weird mild pain started in the middle of the calf after few days, wife suggested it may be thrombosis rather than stiff muscles or tendons. Went to Switzerland's biggest hospital's ER, got blood tests, they were below limit for thrombosis, so I was just sent home.
Pain didn't go away, luckily my wife considered it suspicious and asked another doctor who is an expert on this to recheck. Voila, thrombosis there.
The cause of miss - ER doctors should have done more than just a blood test (even by their own ER protocols, checked that with wife and her colleagues), echography would have shown blood clot in the veins. If it got dislodged and ended up in lungs, that's a quick death within cca 20 mins, ambulance & CPR usually are not sufficient to keep person alive without major brain damage. Or blood clot goes into brain, cutting off some part of it with similar result. One peer from back home died exactly like that (lung variant, the most deadly one).
Yeah, it always seems crazy to me that in a country that is often so economically liberal and free market, medicine is still run like a medieval guild.
It's not quite that one either. The big problem is that most people get health insurance through their employer, and then it's the employer choosing it rather than the insured. Otherwise people would choose different insurance and in particular insurance with lower premiums but higher deductibles, and then use the money they saved on premiums to pay out of pocket for things that cost less than the deductible. And then actually insist on getting a real quote and having the ability to compare prices for non-emergency medicine.
So the main problem is employer middlemen. Which happens in significant part because of tax incentives for employers to do that which you can't get if you do it yourself.
If there is anything I've learned in my country (with national health care) where it's common for doctors to ignore you and say it's nothing, is to be overly pushy and even rude. It could be nothing, but a lot of time instincts are correct, and it's a mild embarrassment if you are making a fuss over nothing, but could be a life or death situation. And you could argue that everyone behaving like this is making it worse, and that might be right. But I remember multiple national headlines in recent years where little kids died of pneumonia after being sent home because they ruled out infection, sometimes even after parents already brought the kid back for the second or third time to the hospital after their condition wasn't improving. I know I'm not making chances even if it means getting a second opinion or driving to a different town to a different hospital, sometimes it's better to take things into your own hands than be complacent and rely solely on the medical system doing the right thing.
If you visit the emergency department of a lot of British hospitals, there will be large posters reminding the doctors "Could it be sepsis?" because of similar instances that occurred over here.
Oh. There is nothing more contra productive than asking an experienced physician “could this not be X”. They will typically go in “if you think google knows better, ask it and fuck off”. Ask me how I know. I think that attitude even has a name (BTW, I’m guilty! If I say “there is a dangling pointer” and the guy starts with another theory, I will dismiss him quickly)
My wife (then girlfriend) and I were at a concert. She went to the bathroom to pee. She came back crying.
I told her she might have a UTI. It was not normal for it to hurt that badly to pee. She denied it. I bought her a UTI test, it came out positive. She was shaking. I told her we had to go to the hospital, she thought they were period cramps.
I call a teledoc. They video chat. She explains the pain shes feeling in her lower back means it’s likely a UTI, the infection has likely reached her kidneys, and we should go to the ER immediately.
In the ER we think they’re going to just give her some antibiotics and send her home. Nope. She throws up. Things go bad fast. Her heart rate is 160. She turns a color I’ve never seen a human before.
The next 3 days were so incredibly hard. But I’m so thankful to all the medical workers that were attentive to us.
Thankfully she makes a full recovery. For a week or so she was lethargic/tired but she’s fully healthy now.
A few months before I had read a story about a woman who’s boyfriend had died from a UTI because they went to a gospital, gave him some antibiotics, and he ending up dying at home because the infection was already too progressed to fight off at home.
Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously.
It’s scary how quickly a UTI or some other benign infection can become sepsis. Take it seriously.
> Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously.
This might sound strange, but I think you deserve some credit for taking it seriously and being there. It’s a documented issue that women’s problems are frequently written off and downplayed as normal things like period pain.
I’m really truly happy to hear that she made a full recovery as well. It is wonderful to hear that she is okay.
Hamish MacInnes, the Scottish climber, was sectioned in a psychiatric hospital because of confusion and delirium caused by an undiagnosed UTI. It took 5 years for the infection to be diagnosed and treated.
I recall with my grandmother it was almost 1:1. If she started sounding just slightly confused or slightly more forgetful than normal, my mom got her tested for UTI. And sure enough, in just about all the cases she had it.
However the first time it did indeed take quite a while before they figured out she had a UTI, and it took a few times before we figured out the pattern.
> Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her
Everybody did well in that instance, including you. Many people won't advocate for themselves, so having someone around who will do it for them is incredibly important.
Everything is optimized for corporations to make more money, to avoid liability and maximize the billable dollars. Doctors want to move meat as quick as possible, most consultations are a couple of minutes! Every doctor has to be part of this rat race because of how the system is designed!
"More than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week."
"Doctors talk about electronic medical records as an unpleasant and frustrating chore. They object to how the charts have evolved to prioritize billing and liability defense over clinical care. And they regard the symphony of well-meaning alerts and pop-ups as a distraction at best."
"The check boxes and templates can aid efficiency, several doctors told me, but they also may distract physicians from the patients right in front of them."
I don't know a single doctor who wants this. Insurance companies want this. Don't blame healthcare workers for the hellish scenarios they are forced to work under.
In my opinion, this is one of the more overlooked side effects of the covid pandemic: stretching resources in hospitals leads to lower quality care for everyone.
Doubt it. A roommate has a life outside of that room, they aren't likely to be there, or know what to do. There's no certainty that a roommate would have been the factor that saved his life.
I'd characterize it as "another saving throw". The roommate might be absent, or preoccupied with his own life, or "staying away from the virus", or too self-doubting to do anything in time.
Similar for Sam's girlfriend Kayla. If she'd been assertive and physically present, she might have saved his life.
Similar any close friend of Sam's.
Similar a bottom-tier resident staff member in Sam's dorm, worried about one of his residents and regularly checking.
(Yes, the U's dorm system "could" officially try to keep an eye on sick residents. But with America's legal system, don't expect any sane university official to sign off on doing that.)
Heartbreaking story. They talk a lot about the possibility of bacterial infection but it was not consistent with the blood tests. It seems he just got unlucky (although should have had a Chest X-Ray).
Trying to reframe it in a coding analogy, there were a few abnormal logs maybe an exception or two but the coder was unable to figure it out and these exceptions happen all the time and so pushed to live anyway. Due to resource allocation issues they were pulled to a different job. Then the site crashed. Just awful.
- Lack of any low-intensity monitored recovery option. If the kid could just have been sent home to a traditional worrying mother, who'd been told to watch for certain warning signs - then he very likely would have lived.
- Critical shortages of front-line medical staff. (ER nurses especially noted here. But a dishonorable mention to the computer systems that the residents were fighting against.)
- However short our medical system might be on front-line resources to treat patients needing care - once it's lawsuit time, resources seem plentiful.
I don't quite understand your third problem. I also don't think the shortage of ER nurses necessarily contributed, as clearly the doctors and the friend thought he was well enough to go home. Definitely agree with the first problem though. We put our kids through a lot of risk by sending them to interstate college...
Sepsis is hard to spot. Whats interesting about this article is that once you get into the details of whatt happened on the patients second visit, its largely about the hospital information systems and how they got in the way.
An automated alert popped up warning that the doctors should consider Sepsis. That alert essentially then blocked progress, and the doctors ended up (essentially) ticking the 'not sepsis' box so that they could get on with their (reasonable) next step which was either ordering an x-ray or starting antibiotics. Then somehow after that, sepsis did not get re-considered.
It was Banerjee’s task to document Sam’s care, and as he began to do so, a pop-up appeared on his computer screen. Sam’s fever and heart rate had triggered an automated warning for sepsis, a potentially life-threatening condition in which the immune system has a dangerous reaction to an infection. It requires speedy intervention. To help the hospital comply with state-mandated sepsis regulations, the pop-up provides a checklist of tests and orders used to identify and treat sepsis.
Agyare had instructed Banerjee to hydrate Sam right away but to wait for the results of Sam’s lab work before ordering a chest X-ray or the strong antibiotics used to treat sepsis.
But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help.
At 8:50 p.m., Welsh showed Banerjee how. From his own computer, he clicked into a field on Sam’s chart to assert that sepsis was not likely: “Based on my evaluation,” the automated note said, “this patient does not meet clinical criteria for bacterial sepsis.” And then Welsh recorded what Banerjee said Agyare had said earlier: “Likely viral syndrome. Workup pending.” Welsh’s name appears on the note, but in his deposition he said he never interacted with Sam. Senior residents often help junior ones in this way, he said. “I signed this note based on the discussion with the provider, Dr. Banerjee, based on his evaluation and the medical management of Mr. Terblanche,” he testified.
...
Sam’s chart is 51 pages long, a catalog of billing codes and abbreviations, check-boxes and shorthand, updates and addenda. The record of the second visit contains numerous contradictions: Sam’s heart rate was documented at 126, yet Banerjee clicked the box “normal.” In one place it says Sam didn’t have a cough, while in another it says he did. The signatures of doctors who testified they never saw Sam — including one who was not in the hospital that night — accompany notes. Vital signs were ordered and not taken, as was an EKG.
medical opinion is that sepsis was not the cause of death despite the family's insistence.
it is likely a rare condition that the doctors missed. this case is sad but being fixated on one diagnosis and building the case around that is just trying to pin blame.
Read all the issues with his diagnosis. One way or another the staff wasn't doing what the record says they did. How could you possibly get to the diagnosis if the tests your claim ordered was never done?
did you read the article? i have a medical background and his hematology results does not support sepsis. the family pointing blame at the hospital for ignoring the sepsis automated warning is barking up the wrong tree and probably why the hospital ignored them.
not saying the hospital is faultless because they clearly failed in this case but as in any courtroom if you charge a criminal with the wrong crime you are bound to lose.
I have found it very useful to discuss possible diagnoses and diagnostic steps with the LLM before going to the ER. Once there, I told them what my expectations were along with the rationale for it. They agreed with 80% of it.
Ultimately the ER was of no use in treatment, but the preparation did help rule out a serious diagnosis.
>In his effort to understand hospital safety and risk, he learned these oft-cited projections: more than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week, Terblanche calculated.
This reminds me of the book The Checklist Manifesto by surgeon Atul Gawande. The book argues that aviation has achieved such a good safety record largely through the use of checklists, and Gawande describes his attempts to apply them to the field of medicine. Recommended. (Edit: I see that checklists are discussed later in the article; I would still recommend the book, as it has thoughts on how checklists can be applied more effectively.)
If you read the complete article it specifically mentions that Sam's condition did trigger some checklists, but those checklists were willfully ignored in favor of expediency.
The problem isn't that there's not enough checklists, the problem is that there's one pilot and he's trying to fly 3 Boeings at the same time from the air traffic control tower.
> These unreliable warnings can lead to “alert fatigue” and, sometimes, a mental habit of discounting them.
This is a problem the airline industry also struggles with and even more checklists is not the answer. A lower workload and better crew resource management is.
I think it's more like Sam's condition did not clearly fit into a checklistable entity. Our heart rate and temperature go up when we have the flu, but we don't all go in to hospital for antibiotics or die at home. Probably they should have done more work-up the second time he came in but as the article points out that could also have been negative. He was probably just too young for checklists built for older people to pick up on his condition.
Being a pilot I can attest how important checklists are, and I do advocate for using them in medicine (have practicing relatives, and I have them tired with that).
But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?)
There are some other 100s of reasons why aviation is safe. Heck, some of them could also be applied NOW: people must rest! I do NOT want to be treated by a doctor doing an idiotic 24hs shift, which is the norm in every country I know of…
There is a whole list of things that can be transferred from aviation to medicine.
Another point I know of is the “handover” of patients. Just as ATC hands over planes from one controller to another, some procedure should warrant the correct transfer of information between shifts. Oh boy I have hear some funny (and some bot at all funny) stories about it.
The long shifts are the most baffling thing to me. AFAIK they're also common in law enforcement.
"Hey these people make life or death decisions. You know what's going to help? Fatigue."
From the outside, it just seems insane.
Unfortunately, healthcare is cursed.
The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever.
Which is why the staff is stretched thin, as a rule and not as an exception.
Not that there's a shortage of other issues that compound that. But even if those issues weren't a thing? The curse is far too strong.
>But maybe you oversimplified the book? (Or the book oversimplified how safety was achieved?)
Quite possibly!
>There is a whole list of things that can be transferred from aviation to medicine.
Please recommend more books!
this is vastly complex than aviation. it is like 10 pilots and co-pilots trying to fly 100 planes and simultaneously switching between them. and with everyone overworked due to no mandated breaks.
no amount of checklist would prevent mistakes. we need legislation to limit medical workload, which is unlikely due to the shortages.
> no amount of checklist would prevent mistakes.
So, don't even try?
Why not both?
FTA: "As hard as the job is, diagnostic accuracy in the E.R. is high overall. But a recent systematic review of published research estimated that 5.7 percent of E.R. patients will have at least one diagnostic error and 2 percent have a setback as a result."
I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care.
2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes.
Costly healthcare due to scrutiny is not the problem with healthcare in the US. The problem is drug monopolies, medical (mal)practice without a license by insurance companies, and the lack of taxpayer funded healthcare-as-a-right.
We need to create an environment where someone like Terblanche feels comfortable advocating for himself without feeling like he's being a burden on the ER, and physicians don't feel like they're wasting time by investigating seemingly trivial cases. Such a situation exists because we are not pouring enough money into healthcare in this country.
It feels high to me because most ER cases should be obvious i.e. heart attacks, car accidents and strokes etc. So if say 10% of cases are non standard then 2% overall is 20% off that.
Not only is the case mix much broader than you imagine but even the three things you listed all have plenty of nuance at the individual case level.
We don't have an anti-heart attack pill. Medicine hasn't developed the post-car-accident protocol. Strokes vary so much in type that they can go unrecognized by competent doctors for years.
> 2-3% error is too high, this is something we _should_ be scrutinizing, and healthcare _should_ be more expensive if the reason it's expensive is that we're pouring more resources into it to get diminishing returns on reducing mistakes
There will be rapid diminishing returns. It may cost 5x to get to 1-2%. Maybe 10x.
An alternative way to throw money at the problem: Instead of trying to further improve accuracy, build out space for more ER beds, and implement continuous monitoring of marginal patients.
Or, build devices to send home with patients which allow for cheap, continuous self-monitoring. That might be a legitimate application of AI actually, if you could use e.g. phone camera tricks to measure more health parameters. Even if imperfect, it could still pick up a few patients who should not have been sent home.
This is mentioned in the article, the fundamental problem is a capacity problem. If patients could be moved out of the ER department to hospital wards then there would be a greater ability for the ER department to monitor patients.
> I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care.
If only. Then the outcomes would be better.
The real reason is that it's ostensibly supposed to be a market but the pricing for everything is completely opaque and shrouded in bureaucracy and corruption.
> I feel like scrutinizing the industry for a 2-3% error on an obviously difficult problem is exactly why we pay so much in the United States for health care
All research I’ve read on this topic finds that it is the US legal system that causes the crazy prices (incentivizing more testing to cover-your-ass and avoid liability etc.)
Many comparative studies on health care cost and quality use the US military as a proxy, as it is free on the condition that you cannot litigate (very coarsely; it is more nuanced).
The costs for treating US military personel is much closer to other countries (while treatment quality remains equal).
It´s not just the legal system. A lot of US Doctors are typically paid on a piece rate basis, and the medical records systems are extremely fragmented, so there is an incentive to order repeat tests (as you get passed around from specialist to specialist), and no incentive to put the systems in to make that unnecessary.
When the consequences are lethal for that 2-3%, that scrutiny is needed.
A set back is not necessarily lethal.
We expect so much from our health care providers, and we sometimes don't appreciate that they deal with a wide array of patients.
Some will come in with a tiny brushing, asking if they are going to die. Others will walk around with a critical condition for days, saying maybe they were a little sore, but they didn't think it was too bad.
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Ok Goodhart!
We might need other measures. It might be damn complex. Ideally 100% would die from "malpractice" (or unknown able issues) because people are so healthy and society is so safe there is barely anyone in ER.
Part of the reason is - people are not machines, its extremely hard to diagnose quite a few situations since every body is a bit unique. Add tons of medications and issues every older person has, within their own unique bodies. Add symptoms like chest or abdominal or head pain which can mean hundreds of conditions, some benign some deadly. Add time pressure to diagnose quickly since that's how medical systems are set up. Wife is a doctor so I can see the perspective from the other side too.
I've had a thrombosis formed in my calf after having a broken leg and using cast. I also caught covid during that time, and from what I've read now I believe it increases temporarily clotting of blood for certain people. When cast was removed, leg was still stiff as wooden plank and ankle didn't bend. I wasn't told to keep the leg higher so I didn't. Some weird mild pain started in the middle of the calf after few days, wife suggested it may be thrombosis rather than stiff muscles or tendons. Went to Switzerland's biggest hospital's ER, got blood tests, they were below limit for thrombosis, so I was just sent home.
Pain didn't go away, luckily my wife considered it suspicious and asked another doctor who is an expert on this to recheck. Voila, thrombosis there.
The cause of miss - ER doctors should have done more than just a blood test (even by their own ER protocols, checked that with wife and her colleagues), echography would have shown blood clot in the veins. If it got dislodged and ended up in lungs, that's a quick death within cca 20 mins, ambulance & CPR usually are not sufficient to keep person alive without major brain damage. Or blood clot goes into brain, cutting off some part of it with similar result. One peer from back home died exactly like that (lung variant, the most deadly one).
We pay too much in the US because of the self-imposed medical labor shortage and that results in mistakes by over-worked staff.
Yeah, it always seems crazy to me that in a country that is often so economically liberal and free market, medicine is still run like a medieval guild.
I thought so but reading the whole article, it seems like there has actually been mistakes. Several.
Someone who goes to the hospital 3 times and still die because of an untreated disease is not just bad luck.
That 5.7% number must be wrong. Ask anybody with a chronic medical condition.
I've had uncountable number of doctor's visits including ER for 37 years before a proper diagnosis was made.
So, your premise is that the US is unique in its lack of checklists in the ER?
Yes. Less scrutiny, more insurance middlemen please.
It's not quite that one either. The big problem is that most people get health insurance through their employer, and then it's the employer choosing it rather than the insured. Otherwise people would choose different insurance and in particular insurance with lower premiums but higher deductibles, and then use the money they saved on premiums to pay out of pocket for things that cost less than the deductible. And then actually insist on getting a real quote and having the ability to compare prices for non-emergency medicine.
So the main problem is employer middlemen. Which happens in significant part because of tax incentives for employers to do that which you can't get if you do it yourself.
>tax incentives for employers to do that which you can't get if you do it yourself.
Is there any problem today that DOESN'T boil down to the government giving preferential treatment to some class or group?
Yes, tons. You choose to focus on the government-aided ones.
the problem is greed.
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> Sam’s girlfriend, theorized that in the hospital Sam didn’t want to be a bother and didn’t advocate for himself
I'm like that and it sucks, I now bring my wife to medical appointments so she can complain for me while I downplay everything.
If there is anything I've learned in my country (with national health care) where it's common for doctors to ignore you and say it's nothing, is to be overly pushy and even rude. It could be nothing, but a lot of time instincts are correct, and it's a mild embarrassment if you are making a fuss over nothing, but could be a life or death situation. And you could argue that everyone behaving like this is making it worse, and that might be right. But I remember multiple national headlines in recent years where little kids died of pneumonia after being sent home because they ruled out infection, sometimes even after parents already brought the kid back for the second or third time to the hospital after their condition wasn't improving. I know I'm not making chances even if it means getting a second opinion or driving to a different town to a different hospital, sometimes it's better to take things into your own hands than be complacent and rely solely on the medical system doing the right thing.
The "there's someone here who'll still be alive to be deposed and/or testify if we fuck up" factor really gets them to be serious.
Especially if the second person peppers their speech with correctly used medical terms.
https://archive.is/MgWJH
If you visit the emergency department of a lot of British hospitals, there will be large posters reminding the doctors "Could it be sepsis?" because of similar instances that occurred over here.
> there will be large posters reminding the doctors "Could it be sepsis?"
I'm not sure how effective this is. Information presented this way quickly fades into background noise..
The patients can also see the posters, and it won't be background noise for them, so they can think of asking about it.
Oh. There is nothing more contra productive than asking an experienced physician “could this not be X”. They will typically go in “if you think google knows better, ask it and fuck off”. Ask me how I know. I think that attitude even has a name (BTW, I’m guilty! If I say “there is a dangling pointer” and the guy starts with another theory, I will dismiss him quickly)
My experience is completely the opposite. It often annoys them, but they are forced to address my question, and that's my goal.
My wife (then girlfriend) and I were at a concert. She went to the bathroom to pee. She came back crying.
I told her she might have a UTI. It was not normal for it to hurt that badly to pee. She denied it. I bought her a UTI test, it came out positive. She was shaking. I told her we had to go to the hospital, she thought they were period cramps.
I call a teledoc. They video chat. She explains the pain shes feeling in her lower back means it’s likely a UTI, the infection has likely reached her kidneys, and we should go to the ER immediately.
In the ER we think they’re going to just give her some antibiotics and send her home. Nope. She throws up. Things go bad fast. Her heart rate is 160. She turns a color I’ve never seen a human before.
The next 3 days were so incredibly hard. But I’m so thankful to all the medical workers that were attentive to us.
Thankfully she makes a full recovery. For a week or so she was lethargic/tired but she’s fully healthy now.
A few months before I had read a story about a woman who’s boyfriend had died from a UTI because they went to a gospital, gave him some antibiotics, and he ending up dying at home because the infection was already too progressed to fight off at home.
Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously.
It’s scary how quickly a UTI or some other benign infection can become sepsis. Take it seriously.
> Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her. I’m so thankful they admitted her and took her care seriously.
This might sound strange, but I think you deserve some credit for taking it seriously and being there. It’s a documented issue that women’s problems are frequently written off and downplayed as normal things like period pain.
I’m really truly happy to hear that she made a full recovery as well. It is wonderful to hear that she is okay.
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Hamish MacInnes, the Scottish climber, was sectioned in a psychiatric hospital because of confusion and delirium caused by an undiagnosed UTI. It took 5 years for the infection to be diagnosed and treated.
https://en.wikipedia.org/wiki/Hamish_MacInnes
I recall with my grandmother it was almost 1:1. If she started sounding just slightly confused or slightly more forgetful than normal, my mom got her tested for UTI. And sure enough, in just about all the cases she had it.
However the first time it did indeed take quite a while before they figured out she had a UTI, and it took a few times before we figured out the pattern.
> Had the person who evaluated my girlfriend not evaluated seriously or just sent her off that could’ve been her
Everybody did well in that instance, including you. Many people won't advocate for themselves, so having someone around who will do it for them is incredibly important.
Everything is optimized for corporations to make more money, to avoid liability and maximize the billable dollars. Doctors want to move meat as quick as possible, most consultations are a couple of minutes! Every doctor has to be part of this rat race because of how the system is designed!
"More than 200,000 people will die each year from preventable medical errors. He was shocked. Conservatively, these estimates amount to at least one fatal Boeing 747 crash per week."
"Doctors talk about electronic medical records as an unpleasant and frustrating chore. They object to how the charts have evolved to prioritize billing and liability defense over clinical care. And they regard the symphony of well-meaning alerts and pop-ups as a distraction at best."
"The check boxes and templates can aid efficiency, several doctors told me, but they also may distract physicians from the patients right in front of them."
> Doctors want to move meat as quick as possible,
I don't know a single doctor who wants this. Insurance companies want this. Don't blame healthcare workers for the hellish scenarios they are forced to work under.
In my opinion, this is one of the more overlooked side effects of the covid pandemic: stretching resources in hospitals leads to lower quality care for everyone.
Non paywalled version: https://archive.is/tJePt
Would have lived if he had a roommate. Do universities do single dorms now
Doubt it. A roommate has a life outside of that room, they aren't likely to be there, or know what to do. There's no certainty that a roommate would have been the factor that saved his life.
I'd characterize it as "another saving throw". The roommate might be absent, or preoccupied with his own life, or "staying away from the virus", or too self-doubting to do anything in time.
Similar for Sam's girlfriend Kayla. If she'd been assertive and physically present, she might have saved his life.
Similar any close friend of Sam's.
Similar a bottom-tier resident staff member in Sam's dorm, worried about one of his residents and regularly checking.
(Yes, the U's dorm system "could" officially try to keep an eye on sick residents. But with America's legal system, don't expect any sane university official to sign off on doing that.)
Heartbreaking story. They talk a lot about the possibility of bacterial infection but it was not consistent with the blood tests. It seems he just got unlucky (although should have had a Chest X-Ray).
Trying to reframe it in a coding analogy, there were a few abnormal logs maybe an exception or two but the coder was unable to figure it out and these exceptions happen all the time and so pushed to live anyway. Due to resource allocation issues they were pulled to a different job. Then the site crashed. Just awful.
This is 99.9% of “news”.
Three major problems to note in the story:
- Lack of any low-intensity monitored recovery option. If the kid could just have been sent home to a traditional worrying mother, who'd been told to watch for certain warning signs - then he very likely would have lived.
- Critical shortages of front-line medical staff. (ER nurses especially noted here. But a dishonorable mention to the computer systems that the residents were fighting against.)
- However short our medical system might be on front-line resources to treat patients needing care - once it's lawsuit time, resources seem plentiful.
I don't quite understand your third problem. I also don't think the shortage of ER nurses necessarily contributed, as clearly the doctors and the friend thought he was well enough to go home. Definitely agree with the first problem though. We put our kids through a lot of risk by sending them to interstate college...
Sepsis is hard to spot. Whats interesting about this article is that once you get into the details of whatt happened on the patients second visit, its largely about the hospital information systems and how they got in the way.
An automated alert popped up warning that the doctors should consider Sepsis. That alert essentially then blocked progress, and the doctors ended up (essentially) ticking the 'not sepsis' box so that they could get on with their (reasonable) next step which was either ordering an x-ray or starting antibiotics. Then somehow after that, sepsis did not get re-considered.
https://archive.is/tJePt#selection-1465.0-1491.52
It was Banerjee’s task to document Sam’s care, and as he began to do so, a pop-up appeared on his computer screen. Sam’s fever and heart rate had triggered an automated warning for sepsis, a potentially life-threatening condition in which the immune system has a dangerous reaction to an infection. It requires speedy intervention. To help the hospital comply with state-mandated sepsis regulations, the pop-up provides a checklist of tests and orders used to identify and treat sepsis.
Agyare had instructed Banerjee to hydrate Sam right away but to wait for the results of Sam’s lab work before ordering a chest X-ray or the strong antibiotics used to treat sepsis.
But Banerjee, a novice, got stuck. He couldn’t figure out how to navigate the template to make some but not all of the auto-populated orders. “This was my first patient that triggered the sepsis pathway,” he explained, in testimony. So he asked Connor Welsh, a third-year resident, for help.
At 8:50 p.m., Welsh showed Banerjee how. From his own computer, he clicked into a field on Sam’s chart to assert that sepsis was not likely: “Based on my evaluation,” the automated note said, “this patient does not meet clinical criteria for bacterial sepsis.” And then Welsh recorded what Banerjee said Agyare had said earlier: “Likely viral syndrome. Workup pending.” Welsh’s name appears on the note, but in his deposition he said he never interacted with Sam. Senior residents often help junior ones in this way, he said. “I signed this note based on the discussion with the provider, Dr. Banerjee, based on his evaluation and the medical management of Mr. Terblanche,” he testified.
...
Sam’s chart is 51 pages long, a catalog of billing codes and abbreviations, check-boxes and shorthand, updates and addenda. The record of the second visit contains numerous contradictions: Sam’s heart rate was documented at 126, yet Banerjee clicked the box “normal.” In one place it says Sam didn’t have a cough, while in another it says he did. The signatures of doctors who testified they never saw Sam — including one who was not in the hospital that night — accompany notes. Vital signs were ordered and not taken, as was an EKG.
medical opinion is that sepsis was not the cause of death despite the family's insistence.
it is likely a rare condition that the doctors missed. this case is sad but being fixated on one diagnosis and building the case around that is just trying to pin blame.
Read all the issues with his diagnosis. One way or another the staff wasn't doing what the record says they did. How could you possibly get to the diagnosis if the tests your claim ordered was never done?
did you read the article? i have a medical background and his hematology results does not support sepsis. the family pointing blame at the hospital for ignoring the sepsis automated warning is barking up the wrong tree and probably why the hospital ignored them.
not saying the hospital is faultless because they clearly failed in this case but as in any courtroom if you charge a criminal with the wrong crime you are bound to lose.
Always get a second opinion from ChatGPT, a third from Claude and a fourth from Gemini.
It is astounding how much more you can learn about your diagnosis from an LLM.
This is precisely the thing that LLMs are great for: spicy auto-complete.
I have found it very useful to discuss possible diagnoses and diagnostic steps with the LLM before going to the ER. Once there, I told them what my expectations were along with the rationale for it. They agreed with 80% of it.
Ultimately the ER was of no use in treatment, but the preparation did help rule out a serious diagnosis.
What could possibly go wrong.