Human Error or Negligence?

Recently I received an email rejoicing that an unborn child had saved the mother's life. My joy was short circuited by my anger. The unborn child should never have been called upon to save her mother's life...that task was the responsibility of the ER physician who couldn't be bothered to do his job.

I've made my share of mistakes. We all have. If you haven't, give it time, you will. We need to have procedures in place to minimize the risk and consequences of human error, but we will never eradicate it. This wasn't human error.

Human error is altogether different from negligence. Human error can happen to the most dedicated caregiver. Negligence is arrogant and self-indulgent. Negligence assumes it knows the answer without conducting the appropriate tests. Negligence dismisses complaints it deems excessive. Negligence is more concerned with the caregiver's convenience than the patient's outcome.

We've all had bad days, annoying patients and patients who are taking advantage of the system. The problem comes when we think we have some sort of at-a-glance superpower that allows us to distinguish sincere patients from phonies with a minimal intake history. When we get to this level of arrogance, we are a disservice to our patients and our profession.

I worked with an orthopedic surgeon who had seen his share of malingerers. He never treated patients like they were lying, even if he thought they were. He believed if he gave them enough rope, they'd eventually hang themselves. But if he assumed they were lying and acted on that assumption, then he might cause harm to an innocent and sincere patient. That was an unacceptable outcome.

But that is exactly what happened in the ER. The doctor minimized the patient's complaints and administered meds without performing any tests. Within a few hours, the patient was in an emergency C-section. While his 2 pound daughter was delivered breathless and his wife lay bleeding out from an unknown source, the patient's husband was escorted by the head nurse to meet with the hospital chaplain to pray. Prayers were answered. Mom was transported to ICU with a breathing tube. Their daughter was taken to NICU, her home for weeks to come. Days would pass before Mom could see or touch her newborn daughter.

How much pain could this family have been spared, not to mention medical costs, if the doctor had assumed the patient was telling the truth? If he had given her the benefit of the doubt and done a complete work-up? What would that decision have cost him? What might that decision have saved this family?  

Are you acting on your assumptions instead of your assessment? Your patients and your profession deserve better.