15 ms·

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 i

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?

didntknowyou 1y ago
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.
- in_cahoots 1y ago
  I think the real implications are much more chilling. As much as we like to believe otherwise, there is always a chance that a seemingly-healthy college kid will drop dead of something that even the best doctor wouldn't have anticipated. And as much as we would like to believe otherwise, the modern healthcare system is riddled with problems that no technology or checklists will fix. It doesn't take someone's death to verify this- just go read your own charts and discharge papers. Even for something relatively routine there are bound to be inaccuracies. Doctors know this, which is why they spend so much time doing handoffs and interviewing patients. We pretend that the medical 'record' is infallible, helping to reduce the mental load on doctors while protecting them from liability. But as this case shows, the 'record' is both inaccurate and not useful in showing fault. It's a paper tiger. I'm not saying we should scrap the whole system, but I do think it needs to be examined in a data-driven manner.
  - fluoridation 1y ago
    What do you mean? Isn't record-keeping a data-driven practice?
    - in_cahoots 1y ago
      No. I can transcribe every interaction with 100% accuracy, but if those notes aren't used in any way it's not data-driven. This article shows that the notes are inaccurate, suggestions using the notes are routinely ignored, and that doctors and legal review think this process is acceptable. There is no professional or legal liability if the records are wrong. And yet if you talk to a medical professional they'll explain that the records are to establish a legal paper trail if anything goes wrong. Some executive(s) have been told that detailed medical records are the solution to so many problems in modern medicine. But they lack either the guts or the expertise to make sure that these systems are actually accomplishing what they set out to do.
      - fluoridation 1y ago
        >suggestions using the notes are routinely ignored Of course. The records are known to not be 100% accurate. Any conclusion you derive from them will be faulty. >There is no professional or legal liability if the records are wrong. Again, of course. In many cases it may not even be possible to show a record is incorrect. For example, if the record doesn't say a test was performed, but the patient insists that it was, is the record wrong, or is the patient mistaken? Or a doctor could incorrectly write down something that only he saw, such as a blood pressure value on a gauge. I would guess a key obstacle to eliminating all these inaccuracies is that doctors don't see strict record-keeping as actually useful in helping patients. Every minute that they're taking notes of dubious future utility is a minute they could spend seeing a patient.
        riknos314 1y ago
        The real issue is the administration of the hospital sees every minute the doctors spend taking better records instead of seeing another patient as a loss of ability to bill someone's insurance for that time. I'm sure there's many doctors who would like to take better notes if they were allowed the time to do so. Maybe the case for better records reducing costs to insurance by assisting in prevention / early intervention is a path forward?
  - naijaboiler 1y ago
    As a surgeon, one truly humbling fact about humans is we are simultaneously incredibly fragile and impossibly resilient. You will be shocked at what people can survive and what flimsy things kill people
    - mandevil 1y ago
      Almost 30 years ago I went to a Penn and Teller magic show. They did their bullet catch (classed up but basically the same trick people have been doing for a century) and other stuff I don't really remember. The trick I vividly remember was just Penn standing behind a table, putting a piece of green cloth (like a surgical thing) over a water balloon, and then giving a long speech of all the damage that friends of his had survived, as he stabbed the balloon (under the cloth) repeatedly in time with his speech, and talked about the wonder of medical science, and how doctors he knew had saved people from all these horrendous accidents and damaging the balloon in sync with every example. And then he removed his hands from the table, holding them up to the audience, leaving the balloon still under the surgical barrier, and said "And the other thing that doctors will tell you, if get a couple of beers into them, is that sometimes people just die for no reason at all." And the balloon collapsed right on cue. I can't seem to find a video of it but I remember it clearly.
  - terminalshort 1y ago
    Technology can fix plenty. I have narcolepsy and was able to diagnose myself after multiple doctors had failed, and luckily I finally found a specialist in narcolepsy who could actually confirm it. Wouldn't be possible without Google (which any of those docotors could have used but didn't). I would probably still be searching for a doctor to actually do his job. Technology can solve plenty of problems. What we need to do is get the doctors out of the loop.
    - kelvinjps10 1y ago
      So you think with just technology, using something like Google or AI, you would be able to correctly self-diagnose with the "doctors out of the loop"?
      - terminalshort 1y ago
        I was in my case (and I didn't even have AI back then) after multiple doctors failed miserably. Of course I needed to get the actual doctor diagnosis to get insurance to pay for my treatment, but that's bureaucracy, not medical science.
    - in_cahoots 1y ago
      I didn't say that technology won't fix anything, merely that it won't fix everything.
    - sarchertech 1y ago
      And for every person who correctly diagnoses themselves despite at odds with what a doctor is telling them, you have 10 people undergoing unnecessary, dangerous treatments because the misdiagnosed themselves.
- haskellshill 1y ago
  People die of missed sepsis all the time, so if you want to lean on your "medical background" to claim this was not the case, you better elaborate what exactly that background is
Bucket0fFire 1y ago
I am an inpatient RN. This conversation is interesting for several reasons: laypeople, unless in hospital as a patient frequently, will have no idea how the "systems" in a hospital intertwine and work together - if we're lucky enough to have them do that. (I wish medical professionals had the energy to talk more about the minutiae of their work just so people better understood.) The "systems" I'm talking about are specialties and roles as well as computer this and technology that. Ethics taught to administrators as well as coders would change a LOT about what we are charting - fact is, hospitals are doing more today to cut costs and avoid liability than they are doing to put patients first. This is obvious just by the fact that they keep declaring they are putting patients first. Rule of thumb: the more the thing is advertised, the less likely it is true despite the understanding that THAT thing is extremely important to their target audience. (not to mention outcomes and statistics show who is getting good care and who is not -lots more to do with finances and financial resources than evidence-based practice, seems to me.) To the point of this article: While I'm charting, I get pop-ups CONSTANTLY. Most are from the software company wanting to give me a tour of the programs features while I'm literally just trying to find a note written by physical therapy, or chart vital signs - I would LOVE to have a proficient skill in navigating EPIC but no hospital where i've worked has given me training beyond the first week. No return to chart training after I've worked with their system for a while, later, when I would know what I'm looking to improve. Other pop-ups are for sepsis alerts as this discussion is about, or (for a RN) fall alerts or skin alerts... All the things that are part of my job and training to be regularly assessing. Here is my summary: What I have seen, for docs and especially for RNs is very obviously just micro-managing to insane degrees of interference, when what works to achieve the right process and best outcome is solid training, retraining, accountability by real people and with respect, and excellent leadership. I DID once work at a hospital where they had enough staff to follow up, answering questions staff had (nursing care or software hacks) and -most important- leadership that did not intimidate, and that could and would talk with the staff member not meeting standards, in real time, getting them past whatever hangup or misunderstanding gets in the way of excellent practice. Follow up and follow up again, with the attitude of teaching (versus punitive micro-management by those whose priority is the bottom line) and supporting the staff to do the right and best thing. Pop-ups and multiple clicks to say "ok" and "yes, I really do mean to do this thing" and "for real please confirm!" add too many wasted minutes, interrupting my thought processes every day day when seconds count for someone's life-saving treatment. I don't know if there is any other industry outside of medicine and nursing where the institution itself literally just adds one road block in front of another, keeping us from focusing and doing what our critical thinking and training have taught us to do. ...don't get me started on Moral Distress and Secondary Trauma because of ignorance around letting us care. . .

didntknowyou 1y ago

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.

in_cahoots 1y ago
I think the real implications are much more chilling. As much as we like to believe otherwise, there is always a chance that a seemingly-healthy college kid will drop dead of something that even the best doctor wouldn't have anticipated. And as much as we would like to believe otherwise, the modern healthcare system is riddled with problems that no technology or checklists will fix. It doesn't take someone's death to verify this- just go read your own charts and discharge papers. Even for something relatively routine there are bound to be inaccuracies. Doctors know this, which is why they spend so much time doing handoffs and interviewing patients. We pretend that the medical 'record' is infallible, helping to reduce the mental load on doctors while protecting them from liability. But as this case shows, the 'record' is both inaccurate and not useful in showing fault. It's a paper tiger. I'm not saying we should scrap the whole system, but I do think it needs to be examined in a data-driven manner.
- fluoridation 1y ago
  What do you mean? Isn't record-keeping a data-driven practice?
  - in_cahoots 1y ago
    No. I can transcribe every interaction with 100% accuracy, but if those notes aren't used in any way it's not data-driven. This article shows that the notes are inaccurate, suggestions using the notes are routinely ignored, and that doctors and legal review think this process is acceptable. There is no professional or legal liability if the records are wrong. And yet if you talk to a medical professional they'll explain that the records are to establish a legal paper trail if anything goes wrong. Some executive(s) have been told that detailed medical records are the solution to so many problems in modern medicine. But they lack either the guts or the expertise to make sure that these systems are actually accomplishing what they set out to do.
    - fluoridation 1y ago
      >suggestions using the notes are routinely ignored Of course. The records are known to not be 100% accurate. Any conclusion you derive from them will be faulty. >There is no professional or legal liability if the records are wrong. Again, of course. In many cases it may not even be possible to show a record is incorrect. For example, if the record doesn't say a test was performed, but the patient insists that it was, is the record wrong, or is the patient mistaken? Or a doctor could incorrectly write down something that only he saw, such as a blood pressure value on a gauge. I would guess a key obstacle to eliminating all these inaccuracies is that doctors don't see strict record-keeping as actually useful in helping patients. Every minute that they're taking notes of dubious future utility is a minute they could spend seeing a patient.
      - riknos314 1y ago
        The real issue is the administration of the hospital sees every minute the doctors spend taking better records instead of seeing another patient as a loss of ability to bill someone's insurance for that time. I'm sure there's many doctors who would like to take better notes if they were allowed the time to do so. Maybe the case for better records reducing costs to insurance by assisting in prevention / early intervention is a path forward?
- naijaboiler 1y ago
  As a surgeon, one truly humbling fact about humans is we are simultaneously incredibly fragile and impossibly resilient. You will be shocked at what people can survive and what flimsy things kill people
  - mandevil 1y ago
    Almost 30 years ago I went to a Penn and Teller magic show. They did their bullet catch (classed up but basically the same trick people have been doing for a century) and other stuff I don't really remember. The trick I vividly remember was just Penn standing behind a table, putting a piece of green cloth (like a surgical thing) over a water balloon, and then giving a long speech of all the damage that friends of his had survived, as he stabbed the balloon (under the cloth) repeatedly in time with his speech, and talked about the wonder of medical science, and how doctors he knew had saved people from all these horrendous accidents and damaging the balloon in sync with every example. And then he removed his hands from the table, holding them up to the audience, leaving the balloon still under the surgical barrier, and said "And the other thing that doctors will tell you, if get a couple of beers into them, is that sometimes people just die for no reason at all." And the balloon collapsed right on cue. I can't seem to find a video of it but I remember it clearly.
- terminalshort 1y ago
  Technology can fix plenty. I have narcolepsy and was able to diagnose myself after multiple doctors had failed, and luckily I finally found a specialist in narcolepsy who could actually confirm it. Wouldn't be possible without Google (which any of those docotors could have used but didn't). I would probably still be searching for a doctor to actually do his job. Technology can solve plenty of problems. What we need to do is get the doctors out of the loop.
  - kelvinjps10 1y ago
    So you think with just technology, using something like Google or AI, you would be able to correctly self-diagnose with the "doctors out of the loop"?
    - terminalshort 1y ago
      I was in my case (and I didn't even have AI back then) after multiple doctors failed miserably. Of course I needed to get the actual doctor diagnosis to get insurance to pay for my treatment, but that's bureaucracy, not medical science.
  - in_cahoots 1y ago
    I didn't say that technology won't fix anything, merely that it won't fix everything.
  - sarchertech 1y ago
    And for every person who correctly diagnoses themselves despite at odds with what a doctor is telling them, you have 10 people undergoing unnecessary, dangerous treatments because the misdiagnosed themselves.
haskellshill 1y ago
People die of missed sepsis all the time, so if you want to lean on your "medical background" to claim this was not the case, you better elaborate what exactly that background is

Bucket0fFire 1y ago

I am an inpatient RN. This conversation is interesting for several reasons: laypeople, unless in hospital as a patient frequently, will have no idea how the "systems" in a hospital intertwine and work together - if we're lucky enough to have them do that. (I wish medical professionals had the energy to talk more about the minutiae of their work just so people better understood.) The "systems" I'm talking about are specialties and roles as well as computer this and technology that. Ethics taught to administrators as well as coders would change a LOT about what we are charting - fact is, hospitals are doing more today to cut costs and avoid liability than they are doing to put patients first. This is obvious just by the fact that they keep declaring they are putting patients first. Rule of thumb: the more the thing is advertised, the less likely it is true despite the understanding that THAT thing is extremely important to their target audience. (not to mention outcomes and statistics show who is getting good care and who is not -lots more to do with finances and financial resources than evidence-based practice, seems to me.) To the point of this article: While I'm charting, I get pop-ups CONSTANTLY. Most are from the software company wanting to give me a tour of the programs features while I'm literally just trying to find a note written by physical therapy, or chart vital signs - I would LOVE to have a proficient skill in navigating EPIC but no hospital where i've worked has given me training beyond the first week. No return to chart training after I've worked with their system for a while, later, when I would know what I'm looking to improve. Other pop-ups are for sepsis alerts as this discussion is about, or (for a RN) fall alerts or skin alerts... All the things that are part of my job and training to be regularly assessing. Here is my summary: What I have seen, for docs and especially for RNs is very obviously just micro-managing to insane degrees of interference, when what works to achieve the right process and best outcome is solid training, retraining, accountability by real people and with respect, and excellent leadership. I DID once work at a hospital where they had enough staff to follow up, answering questions staff had (nursing care or software hacks) and -most important- leadership that did not intimidate, and that could and would talk with the staff member not meeting standards, in real time, getting them past whatever hangup or misunderstanding gets in the way of excellent practice. Follow up and follow up again, with the attitude of teaching (versus punitive micro-management by those whose priority is the bottom line) and supporting the staff to do the right and best thing. Pop-ups and multiple clicks to say "ok" and "yes, I really do mean to do this thing" and "for real please confirm!" add too many wasted minutes, interrupting my thought processes every day day when seconds count for someone's life-saving treatment. I don't know if there is any other industry outside of medicine and nursing where the institution itself literally just adds one road block in front of another, keeping us from focusing and doing what our critical thinking and training have taught us to do. ...don't get me started on Moral Distress and Secondary Trauma because of ignorance around letting us care. . .