Tuesday, May 13, 2014

Report from the field

Warning:  This is the kind of story that will leave you fuming.

At a major academic medical center, a friend was recently scheduled for a tricky off-label injection into her leg to deal with a long-term disability.  The previous injection had proved to be helpful. Knowing that the placement of the injection was critical, my friend specifically requested that the attending physician, rather than a trainee, administer it.  When the time came for the injection, the attending left the room, and the trainee delivered it--into the wrong place.  My friend immediately knew something was wrong but decided to wait a few days to see if there was any long-term effect.  There was, and her physical condition reverted to a much earlier period, setting her back over a year in treatment progress.

She reported this to the attending and also talked to the site manager at this hospital.  Neither was responsive.  Indeed, the site manager said that my friend should have expected a trainee to handle the case because it is a teaching hospital and because it was an elective procedure.  No one admitted that a mistake had been made or apologized in any way.

She asked to get a second opinion as to the cause of the problem and the next steps. The doctor chosen for the second opinion was rude to her, yelled at her, and refused to discuss the data my friend brought in for the meeting.

The president of the hospital likewise was rude and unresponsive.

Meanwhile, from a third party, my friend learned that the original attending knew that things were awry in the clinic that day, that she was in error by not being present for the procedure, and that the trainee indeed caused the damage.  The doctor did not tell the patient any of this, but panicked and hid all of these facts.  My friend also learned that the other people at the hospital from whom she had tried to receive satisfaction were protecting the attending.

But this hospital is at the top of the list in US News and World Report.


Ralf Lippold said...

A more than sad story. The culture of clinics, and hospitals seems to stem from a time when expert were everything and without flaw.

Where there work people, there always is a chance that processes go not in the wanted direction. Questioning, and admitting what has gone wrong is the FIRST and NECESSARY step to learn for the FUTURE!!!!

Thanks Paul for sharing this story

Anonymous said...

This is medicine as it was practiced 'in the old days'. It appears their top ranking has made them arrogant enough to think change is not necessary. I don't usually advise this, but time to get a lawyer.


Dan and Naomi said...

From Facebook:

Dan Ford: Cover-ups are unethical, plain and simple...

Naomi Kaufman Price: Appalling. Your friend, I hope, has followed up with the state med board, etc? And isn't failure to supervise a resident a big no-no? So sorry.

Anonymous said...

This is why there is such a loss of faith in doctors now. It is not going to get any better, and its going to get much worse. Doctors complain about $$$ and the like, the bigger problems are going to crop up because of the deny and defend, the obvious $$$ over life attitude.

Sad to say but I predicted the guy who went in shot the doctors for a problem. I said once you start getting people seeing & hearing a constant litany of not taking responsibility for fixing problems, the response & the lack thereof, you are going to see people doing desperate things.

Especially when they know they could be prevented.

Paul Levy said...

I don't understand your second paragraph. Are you blaming the patient here for wanting the injection?

Anonymous said...

Amazing display of cowardice. And arrogance of course given prominence in academic medical circles.

Perhaps these fine physicians and the administrators can ruminate on the following:

"The Moving Finger writes; and,
having writ, Moves on: nor all thy Piety nor Wit Shall lure it back to cancel half a line
Nor all thy Tears wash out of a Word of it." In the Rubaiyat of Omar Khayyam

Mitch said...

Fuming indeed....amazing, and I suspect all too common.

Samantha Johnson said...

From Twitter:

An unfortunate event and worse response.

Mark Graban said...

From Twitter:

This story is not surprising, Boston or otherwise.

Brian Betner said...

From Twitter:


C Johnston said...

That is a sad and disturbing story, and motivating to fix things and prevent stories like these in the future. Thanks for sharing.

Anonymous said...

If it were me, I probably wouldn't sue over the event, itself. But I wouldn't hesitate for a moment to drag them into court for the coverup and mistreatment afterward.

Anonymous said...

Anon 12:46, that was precisely my intention in my comment above. Unfortunately, once all the relevant players have already been rude and unresponsive, a strong letter from a lawyer, whether or not the intention is to follow with a lawsuit, is often the only thing to make them listen. What we really need is a '7 on your side' for patients. Part of that is naming the involved hospital, although Paul may want to protect privacy.

nonlocal MD

Emily said...

Paul,I think what Anon 7:11 was referring to in his second paragraph were doctors who have been shot by their patients. Reported in the news recently were 2 urologists who were killed by angry patients over bad outcomes. One in Reno, the other in So. Calif.

Paul Levy said...

Ah, thanks.

Jeanne said...

Thanks for sharing this story, Paul. It's so important we keep this stuff front-and-center to change the culture. I am sharing this with the Sorry Works! social media.

Jim Conway said...

Paul, Doug was kind enough to point me to the important post that I had originally missed.

As I read this sad, disrespectful story, I thought of a recent discussion in the Harvard School of Public Health classroom. We were talking about mission, vision, and values. Organizations have all those things… I’m sure this organization does. I’m also certain that they say all the right things… respect, compassion, values, patient, family, community, high quality. As Ed Schein has taught us, and we discussed in class, this isn’t just about what we say but what we do, for every patient, every day, every time.

All this patient wants is for this organization and its leaders to do what they no doubt have written down and say. Yes, today healthcare organizations must be held accountable to their mission, vision, and values and assure that all elements are in balance.

Thanks as always, Jim