To Err Is Human

Medical error leads to thousands of deaths every year.  That's a scary statistic, no matter which side of the gurney you find yourself.  And it's one that has poked uneasily at the back of my mind since my earliest days of nursing.  The majority of people who enter the field of healthcare do so because they want to help people, to do their part to ease the suffering of this broken world. Imagine how devastating to instead end up hurting someone because you make a mistake. I remember a nurse who unintentionally caused the death of a 16 year old saying in court in a voice heavy with grief, that she would be serving a life sentence of shame and remorse. A seasoned, competent nurse in my corner of the country committed suicide not too long ago in the wake of a fatal error. It's a fear that plagues every one of us who has the potential to cause harm when we've devoted our lives to doing good.

It's one of those moments that is seared in my memory. I was in my early years of emergency nursing and I'd just given a handful of different medications to one of my patients. As I sat down to chart the medications, suddenly I noticed something I'd overlooked. In the middle of the list of IV medications one was subcutaneous - to be given under the skin as opposed to in the vein. But I had just given them all IV. I could feel the heat spread up from my chest, making my face burn and my legs start to feel weak as I realized my mistake. I had just made a medication error.  Was it serious? Would it hurt her? I did a quick shakey google search to check if the med could be safely given other routes.  I knew I had to tell the doctor. I didn't want to tell the doctor. She'd think I was an idiot. All that hard earned respect, the proof of my competence, I didn't want to risk losing it! The strength of my desire for self preservation surprised me. In the end my concern for the patient and my conscience won out, and the doctor responded by swinging her head back and dropping the Fbomb before trotting away to talk with the pharmacist.  In the end it turned out the medication could be safely administered IV. No harm no foul. But that feeling never left me. The shock of how quickly and easily an oversight could result in harm. How a seemingly ordinary shift could suddenly alter lives. The potential for error went from hypothetical to terrifyingly real.

In the end I was thankful for that close call. Because I think one of the best safeguards to error is a healthy sense of fear. I don't mean anxiety, but an ever mindful respect for the potential for catastrophe that keeps you a little more alert, a little more attentive, a little less auto pilot.  When I first learned to drive I remember being acutely aware of the amount of power and speed a vehicle has and how easily a mistake could result in harm or death.  But the longer you drive you start to lose that sense. You get comfortable. You stop paying as close attention, your mind wanders,  you shoot off a couple of texts at 65 mph. And most the time, this doesn't result in harm - adding to your false sense of security until it's too late.  As healthcare workers I think a little bit of fear is our friend. Fear alerts you to danger and makes you pay attention. People's lives are in our hands, and there will always be danger. Ours can never be 'just another day at the office', the stakes are just too high.

How Primary Doctors Set ERs Up For Failure

I know they don't mean to. I know they are trying to do their best by their patient and can't understand how it feels on our side- but here is a way that people's primary doctors set ERs up for failure, and it can basically be summed up in this phrase: "I'll call the ER and let them know you're coming."

Every day, several times a day, those of us working the front desk will hear these words, strong and filled with confidence of the power they surely contain, "My doctor sent me. He called, you should be expecting me." No other explanation should surely be needed, open wide the gates and let me pass! Usher me past all these poor waiting souls who were not likewise sent by their doctor. How disappointing when the poor chap at the desk has to say, I'm sure they did, but you'll have to get in line. Because you see, it's all good and well for your doctor to send you to the ER if they have concerns that can't be addressed in the office, and if they want to call us about it that's fine too, but very rarely will it change anything about the ER process. You will still have to be triaged, and you will still be sorted according to the actual urgency of your condition.

But when people hear 'go to the ER we'll let them know you're coming', they hear "you need immediate treatment and you will get that as soon as you walk in the doors". But that is a faulty perception, because lots of people get sent by their doctors offices, few of them need some immediate treatment or testing, and rarely will their doctors call "bump them ahead" in line if there's a wait. But since before entering our doors they have that expectation, any form of waiting or perceived lack of urgency on our part will mostly be interpreted as negligence.  People seem much more likely to be angry or indignant at waiting if they were sent by a doctor who 'called ahead'.

 There is also the perception that since their doctor called, as soon as they state their name we should know their story.  "Oh Mr Jones, yes! We hear you may have a kidney stone! Come this way please, excuse me everyone! The doctor is waiting for you..." I can't tell you how many times someone comes to the front desk and states their name confidently, pauses awkwardly as they await recognition, then state a little perplexed- "My doctor should have called..."  Immediately set up for disappointment.   I can understand its a good customer service move on the PMD end of things as no one wants to hear they should go to the emergency room, and no one wants to hear they may end up waiting a couple of hours once they get there, so an offer to call ahead seems caring. But the problem is that it rarely makes any actual difference on our end, it just creates an expectation that too often can't be met, and a faulty perception that leaves the ER looking like the bad guys.

So there ends my rant. Just remember that if your doctor sends you to the ER, you should go. But if they really think that you need treatment that cannot wait, they will call you an ambulance. If they do not call you an ambulance and the ER is busy, you may still have to wait.