Saudi Journal of Kidney Diseases and Transplantation

DOCTORS DIARY
Year
: 2004  |  Volume : 15  |  Issue : 4  |  Page : 513--514

Early Scary Days in Medical Practice


Abdullah A Al-Khader 
 Division of Nephrology, Hypertension & Renal Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Correspondence Address:
Abdullah A Al-Khader
Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia




How to cite this article:
Al-Khader AA. Early Scary Days in Medical Practice.Saudi J Kidney Dis Transpl 2004;15:513-514


How to cite this URL:
Al-Khader AA. Early Scary Days in Medical Practice. Saudi J Kidney Dis Transpl [serial online] 2004 [cited 2019 Nov 21 ];15:513-514
Available from: http://www.sjkdt.org/text.asp?2004/15/4/513/32886


Full Text

Peter was clearly distraught. Funny, I thought, this is not usual for him. I have known him since we joined the medical school at UCH. That was six years earlier. And we both did intercalated BSc degrees, he in Anatomy and I in Biochemistry. I had few friends, mostly like me from the so called developing countries. Peter was one of the few English boys I got to really like, and we became close fiends. I have been invited by him to his home in the West Country. I probably learnt how to behave "properly" the English-way by these visits and have learnt how the English can be really kind once you know them. However, this is another story but I could see how Peter was brought up "to do the right thing". This I noticed, after a fair amount of observation was a chara­cteristic of the upper class and some of the middle class of the British society. It was interesting to me to observe the differences in my society to the British society even in the way one uses words, body language or even eat. These, I realized with time add to the richness of human experience…….. "What is up, Peter"

I had just finished an early morning round on my patients and was sitting in the doctor's common room having coffee and reading a newspaper which I put aside when I saw Peter coming towards me.

"But for the grace of God, I almost killed a patient this morning", he said.

This is not good, I thought, since we had just qualified. In fact, we were just two weeks into our internship. Peter who had been a top student was doing his internship in Internal Medicine with a cardiology firm and I, with the Professor of Medicine who is a nephrologist (kidney specialist). I remember the Professor's first words to me when I joined him as an intern. "You are not a student anymore. I will address you as Dr and I will trust your judge­ment. I will not query your input too much. I will see you only during the ward rounds and will leave you and the registrar to deal with the patients. However, you must inform me immediately if a patient dies." I often wondered why he wanted to know about the patients' death but not about their conditions while they are alive. It was only many months later that I learnt that he once told a relative of a patient, while they were in the lift, how well his mother was doing and that she will be able to go home soon, only to be informed by the relative that she has been dead for a couple of days.

"Peter, "I asked" what happened? You really look like a ghost"

"I had a patient with frequent ventricular ectopics (a dangerous form of heart beat irregularity) for which I prescribed lignocaine. But instead of injecting 100 mgs, I gave her 1000 mgs. She, as you would expect, had immediate seizures and settled only when I gave her valium. Before you ask how I made this stupid mistake I will tell you. The ampoule had written on it 100 mgs and I just drew the liquid in it and injected all the 10 mls of it. It was only after the event that I reread what was on the ampoule. 100 mgs/ml"

Mistakes are fairly common in Medicine and especially in hospitals. It is said that over 200,000 patients die annually in the USA from medical errors and/or have some sort of signi­ficant injury. Unfortunately, the public and the press often mix up true errors, negligence or simply expected side effects.

I know of a young patient who received chemotherapy and irradiation for presumed lymphoma (a form of cancer). After follow-up of over two years, one of the doctors bothered to study his fattening file to find the histology report describing a benign condition and not cancer. So, that long and dangerous treatment was given unnecessarily. When queried, the treating physician said that he was informed verbally that it was cancer and on that basis he started the anti-cancer therapy.

Of course, the doctor should study the files properly but in a busy outpatient clinic this may not be possible and doctors tend not to do so when they think they know the patient very well. Now in this case whose fault is it? The reporting pathologist, the cancer specia­list, the other doctors who saw the patient along the way without noticing the wrong diagnosis or the radiotherapy specialists who actually gave the radiotherapy dose or the technician who gave the intravenous drugs?

I was trained to absolve the people who are meant to carry out the instructions of the senior physician unless these are blatantly wrong. However, this and other examples show how easy it is to make errors and I have learnt that these frequently arise from a faulty system amplified by complacency and not due to a personal fault. In this example, the fault lies in that the cancer specialty accepted the oral report which was later changed as a written report.

The sooner our institutions learn this, the quicker will errors disappear because then, people will concentrate on improving the system that allows mistakes to happen.

We should take a page from airline industry which adopted this philosophy to perfection thus minimizing human errors to the absolute minimum.