All PostOctober 4, 2020by adminA doctor gave me an inept diagnosis for a neurological problem. I should know: I’m a neurologist. – The Washington Post

https://www.washingtonpost.com/health/hospital-misdiagnosis-mistakes-ignored/2020/10/02/7bac2d10-f851-11ea-be57-d00bb9bc632d_story.html

As a career scholastic neurologist, I believed a doctor examining his own medical condition in his own specialty, meaning to inform, would be an illuminating and teachable moment for medical staff and trainees and a healing opportunity for me.In 1999, the Institute of Medicine issued its landmark report, “To Err is Human: Building a Safer Health System,” which estimated that as numerous as 98,000 healthcare facility deaths a year were triggered by medical errors. In action, numerous health centers altered their procedures and practices, but two years later, as my experience suggests, even the finest hospitals and doctors remain resistant to confessing mistake, in large part due to the fact that they fear malpractice lawsuits.Recent research study strengthens this view. Several years back, scientists posed 2 hypothetical circumstances involving medical error– a delayed breast cancer diagnosis, and a postponed action to a patients signs because of uncoordinated care– to 300 primary care doctors. Further, when hospital representatives, rather than physicians, react to medical errors by rejecting, reducing or covering them up, physicians frequently conclude that their health centers have no interest in facing these errors head-on. The aphorism, “A physician who treats himself has a fool for a client,” only applies if proficient care is available.For me, 4 years of medical school and five years of postgraduate training had an uniquely individual advantage.

I felt fine afterward, however within hours I developed neck discomfort with tingling and tingling radiating down my arms. I went to the emergency department (ED) of an elite medical center two days later, telling the personnel that I was a neurologist with presumed cervical (neck) spine illness and possible spine and root compression, a condition in my own specialty. I asked to have a cervical MRI scan performed, plus blood studies to identify a possible spinal column infection, as Ive had one before.The back expert checked my reflexes with the side of his hand. When I asked about his reflex hammer he responded that he didnt have one or need one– even though this amounts evaluating the heart or lungs without a stethoscope.He at first ignored to take a look at for the Babinski indication, a classic scientific test, which, if favorable, would have highly recommended back cord compression. When I mentioned on this failure, he carried out the treatment improperly. He inspected my feeling with his forefinger and did not take a look at other experiences, hand, coordination or gait dexterity.The MRI revealed specific spine compression due to arthritis, and a neck mass behind the spine canal. It was an abscess– a pus collection– however the health centers radiologist read it as an embolism. The blood research studies exposed active infection: marked elevations in inflammatory markers, plus increased white blood cells of the “ought to be concerned” range. These apparent and harmful abnormalities were not pursued and I was not informed of them. I spent six hours in the ED, then was discharged and informed to follow up with a spine cosmetic surgeon within 2 weeks.Two days later on, I traveled house to Maine and reviewed my medical records online. I recognized the severity and complexity of my problem and went to my medical facility, was confessed and underwent immediate spinal column surgical treatment and long-lasting intravenous prescription antibiotics. Left without treatment, these irregularities might well have triggered a disaster: I might have ended up being quadriplegic, not able to move my limbs and even breathe on my own. My action to the ED see can not be expected of the typical patient, who would have been in deep trouble.While recuperating, I sent several letters detailing the specifics of my lacking care to the medical facilitys president. The healthcare facilitys representatives responded, declining to confess fault or say sorry for these failures. The spine service manager even excused the consultant, stating he “carried out the examination to the very best of his ability.”The lack of acknowledgment of the major infection went unmentioned in the representatives letters.In view of the numerous severe medical errors dedicated throughout my ED visit, I provided to present and discuss my case to emergency and spinal column service staff. As a profession scholastic neurologist, I believed a doctor examining his own medical condition in his own specialty, intending to educate, would be a teachable and illuminating moment for medical personnel and students and a recovery opportunity for me.In 1999, the Institute of Medicine issued its landmark report, “To Err is Human: Building a Safer Health System,” which estimated that as lots of as 98,000 health center deaths a year were triggered by medical errors. The report made national headings and produced much subsequent conversation on the causes and results of medical mistakes, and the principles of transparency and disclosure. In action, many health centers altered their treatments and practices, but 2 decades later on, as my experience suggests, even the finest healthcare facilities and doctors remain resistant to admitting mistake, in big part since they fear malpractice lawsuits.Recent research reinforces this view. Several years earlier, researchers postured two hypothetical circumstances involving medical mistake– a postponed breast cancer diagnosis, and a delayed action to a patients symptoms since of uncoordinated care– to 300 primary care physicians. More than 70 percent of the physicians surveyed said they would provide “just a restricted or no apology, limited or no description, and restricted or no details about the cause.” Even more, when healthcare facility representatives, rather than physicians, react to medical errors by rejecting, lessening or covering them up, doctors typically conclude that their hospitals have no interest in facing these errors head-on. Sure sounds like my situation.My experience likewise exhibits the phenomenon called “the normalization of deviance” talked about by Diane Vaughan in her 1996 book on the area shuttle Challenger disaster. Vaughan concludes that several issues preceding the shuttle launch were acknowledged, however then justified, and “stabilized” when they didnt cause a catastrophe– until they eventually did.Since the spine consultant did not own a reflex hammer, nor believe he needed this standard tool, nor know how to do an appropriate neurological assessment, and he and the ED staff did not acknowledge that the raised inflammatory markers were indisputable evidence of serious infection, I might not have been the very first client so poorly evaluated– and, without doubt, not the last. Even more, the consultants supervisor excused his errors, thereby considering his deviances acceptable.The responses to my letters came from health center client service representatives, therefore this rejection and normalization was institutional, in support of Vaughans property “that specific behavior can not be understood without taking into account the ecological and organizational context of that behavior.” Vaughan mentions that sometimes the normalization of deviance just becomes obvious after whistleblower revelation.I am that whistleblower, “the canary in the coal mine.”The health centers administrator charged with patient communication and resolution, and a commonly recognized advocate for these topics, was uninformed of my complaints until I found her by happenstance 18 months later on (listening to the TED Radio Hour while in my car) and called her. She was at first encouraging of my request to provide my own case for conversation and analysis, now, more than 10 months later, she has yet to follow through.She wrote to me: “Hospitals do not seem to know what to do with the opportunity you provide. I dont think the challenge is special to [this institution] A forum for these kinds of conversations– useful, informative patient feedback does not exist.”Initially, she informed me that since my SOL is up I may have a better chance of making my presentation. I asked: “What is a SOL?” She stated: “statute of restrictions.” I stated: “I do not wish to take legal action against, I wish to teach.”Of course, if I had actually been quadriplegic on a respirator I would have sued. However considering that I conserved my own skin, that was not required. The aphorism, “A physician who treats himself has a fool for a patient,” just applies if competent care is available.For me, 4 years of medical school and 5 years of postgraduate training had an uniquely personal benefit. Im just sorry that a teachable minute for the benefit of future clients, and a recovery activity for me, was missed.Steven Horowitz is a retired academic neurologist who continues to teach medical students as an accessory medical professor of neurology at the Tufts University School of Medicine. He is also on the teaching professors of the Maine Medical Center.

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