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Things medical personnel should not do

Things medical personnel should not do

Here are some tips from an experienced former provider—me. Nude Pictures… Do not take nude pictures of fellow employees. A woman unit secretary in the operating room of a hospital in Greene County, Pennsylvania said while she was anesthetized for an incisional hernia repair, an operating room nurse took photographs of her naked body and later showed them to several coworkers. The patient, known only as Jane Doe, has filed suit against the hospital, several of its employees, and the surgeon who operated on her because he did not report the nurse who took the pictures to hospital administration. According to the local newspaper, the OR nurse was fired after Ms. Doe reported the incident, but things did not go well for Ms. Doe either. After she returned to work, she was blamed for what happened and treated poorly by the staff. Someone wrote her a note that said, “What were you thinking?” and added an obscenity. She returned to work and suffered “migraines, anxiety, and insomnia.” After she took an unpaid leave recommended by her physician, the hospital terminated her. As is typical of lawsuits such as this [see my post of December 28, 2017], hyperbole must be used in order to fill up the 39 pages of the complaint. Despite no claim of a postoperative complication, Ms. Doe’s lawyer said she was at increased risk of infection because a cell phone, not necessarily one with more bacteria than a toilet seat, was taken into a sterile operating room. Murder… Do not [allegedly] murder a patient. An anesthesiologist was arrested and charged with murder in December because his...
Ordering unnecessary laboratory tests continues to be a problem

Ordering unnecessary laboratory tests continues to be a problem

Unnecessary testing wastes money and can lead to further testing. Why does it occur? Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing. Of 1580 attending physicians, fellows, residents, physician assistants, nurse practitioners, and nurses sent surveys, 837 (53%) responded; 393 (47%) were RNs, and 80% of those nurses felt that daily laboratory testing should be done on all patients. Nurses strongly felt that patient safety and protection against malpractice litigation were enhanced by daily laboratory testing. Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests. Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey or the tests were ordering themselves. The authors of the JAMA Internal Medicine study, done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done. Another recent survey published in Hospital Medicine asked internal medicine and general surgery residents at the Hospital of the University of Pennsylvania why they ordered unnecessary tests as...
How has United Airlines done since the doctor was manhandled?

How has United Airlines done since the doctor was manhandled?

  Three months ago I blogged about the doctor who was dragged off a United plane in Chicago and the airline’s response to the incident. The CEO claimed it was a system problem, but I thought human error and a lack of common sense were the major factors. I ended that April 17th post with three predictions: 1. The United fiasco will be forgotten by the end of this month. 2. People who said they will never fly United again will do so when they need to go somewhere serviced only by United or when United’s fare is the cheapest. 3. United will experience another “system error” very soon. Number 1 more or less occurred. I’m not sure about number 2. Regarding the third, here are some of the “system errors” United has experienced since then. A rare giant rabbit being shipped from London was found dead in the cargo area at Chicago’s O’Hare International Airport. No explanation of the cause of death was forthcoming. Probable human error. Two newlywed passengers recorded a video of jet fuel pouring out of the wing of a United plane about to take off from Newark to Venice. The husband “ran to let the crew know that something wasn’t right, but said they ‘yelled’ at him and told him to sit down, saying everything was normal.” When a crew member finally looked out the window, the flight was canceled. The couple was hassled when they asked United to book them on another flight. Eventually a Delta flight was arranged but they had to sleep on the floor at Newark Airport. Several human errors—left...
Will robots ever be able to perform surgery independently?

Will robots ever be able to perform surgery independently?

Will robots ever be able to perform surgery independently? And if they can, should they? In my last post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.” But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots. The authors say some devices are already at level 3. A surgeon can tell a robot to put in a row of sutures, and the robot will do so without hands-on control by the surgeon. Major issues — cyber security, privacy, risk of malfunction resulting in harm to the patient — arise as the robots approach complete autonomy. The cost of satisfying FDA regulations escalates as the robots take on more high risk activities. For such a device, the cost of premarket approval approaches $100 million and takes 4½ years to accomplish. A completely autonomous level 5 surgical robot will actually be practicing medicine raising the question of robots not only requiring FDA clearance but also licensing by medical organizations and board certification. Will they need to take examinations and participate in maintenance of certification? A huge problem already affecting pilots involves the deterioration of skills when ceding all control to the robot. Crashes, notably Air France Flight 447 from Rio de Janeiro to Paris, have occurred when computers malfunctioned and human pilots had to take control. The Air France incident occurred when ice covered a sensor resulting in autopilot disengagement. The human pilots failed to recognize the plane had stalled, and...
The Burnout Paradox: Why Are We Still Surprised?

The Burnout Paradox: Why Are We Still Surprised?

If you go to medical school, you will be stressed—bigly. It should not come as a surprise. Two posts on the Kevin MD website highlight the problems facing many medical students today. The first was by an anonymous rising fourth year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.” The second was by another anonymous student who described how miserable he (or she) has been since he started medical school. He said “’burnout’ is the word I would use to best describe my medical school experience.” On the day he wrote his post, he was about to text the surgery residents to tell them he would not be there for the last day of his rotation because he was too anxious. He mentioned a strong family history of anxiety disorders and being diagnosed with depression and anxiety as he was applying to medical school. He did not disclose this during the application process. Burnout is not limited to a few students. A literature review in 2013 found “at least half of all medical students may be affected by burnout during their medical education.” Nor is the problem confined to medical students. A national survey published in Academic Medicine in 2014 found that 58.2% of medical students, 50.8% of residents/fellows, and 40% of early career physicians screened positive for depression. Last week, Medscape’s 2017 Lifestyle Report, a survey of practicing physicians, found that 51% were burned out—an increase from 40% in 2013. The...
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