We are living in the darkest days of medicine in one hundred years. Many of us have been affected by COVID-19, and understand firsthand how it robs us of our energy and our ability to think creatively as well as sequentially. As a patient who was hospitalized twice for this virus, I can honestly understand what sleep deprivation is and the fact that I could not compose an article this month because of a Covid cloud or fog. My ability to think and to write a simple article have been trifled with. What about you PAs and NPs that have had this disease and were forced to return to work? How has this effected your critical thinking and your ability to do your best for your patients? What medical errors might you have made and what errors are you not even aware of? Beware both errors of omission and commission.
I received this from an unknown source a few weeks ago, but it demonstrates our exhaustion. Today I am not ok. I am an ER PA that has been pushed and pushed. I am tired of the non-believers. I am tired of being coughed on by patients who refuse to wear a mask. I am tired of not being able to see my family. I am tired of being told what I will and what I won’t do. I am tired of missing holidays and big events. I am tired of extended family members judging me for not going to family events with 30+ people. I am tired of being my kid’s teachers. I am tired of working extra shifts and extra days. I am tired from my last shift and my last patient of the day being a COVID code blue. I am just tired. And I am tired of being afraid if I get it (and I have heart problems) that my kids might grow up without a mom. I am tired of not being able to hug or even see my parents. And tomorrow when I go back to the ER, I will do it again. And I will be ok.
This young PA summarizes all of her frustrations, the constant ebb and flow of patients, the inability to cure all her patients, the smell of death surrounding her and the frustration of being in healthcare today. They call us front line heroes, but fail to give us the PPE to remain healthy and not infect our families. I remember feeling like this when in military combat. I remember the blood, cries of the wounded, the stench of death and the endless procession of Medivac helicopters bringing yet more young troops to be triaged and hopefully treated. I remember after 72 hours of this torment, walking to my hooch only to hear the chopping sound of yet another helicopter. I sat down and cried from exhaustion.
In today’s crisis, what errors are most common for a PA/NP returning to employment when lethargy still lingers, and decision making may be impaired?
- The possibility of wrong side surgery.
- Wrong patient identification.
- Wrong medication to wrong patient.
- Wrong dosage and failure to look for contraindications and side effects.
- Improper calculation of insulin dosage.
- Failure to read ECG prior to administration of certain antiemetics.
- And, chief among the potential errors relates to insurance coverage for malpractice litigation.
Here are the essential questions you need to be asking about this last point:
- Who is the underwriting insurance company?
- What is their A.M. Best rating?
- Who owns the malpractice policy which covers your professional performance?
- Are you covered by your employer, group or hospital?
- Does your insurance outline coverage for your specific specialty tasks?
- Do you follow employer established protocols and proper procedures?
- Have you seen your company’s policy, listing you by name and is it up to date?
- Or do you maintain your own personal liability insurance policy?
Knowledge of the above can guard against potential legal catastrophes in the future but being unaware of these is the most common error of new clinicians.
Never before have health care professionals been forced to work in their hospitals while they are compromised. Hospital administrators have always been tasked with the care and safety of their patients as well as their employees. Today’s dire situation where people are being triaged to see if they deserve care based on their ability to overcome their illness has brought us to our knees as medical providers. Many acknowledge both the obligation and duty to provide care, but is the quality of that care something we can be proud of or something that can be defensible when we have a negative outcome? I empathize with my colleagues on the front lines and only ask that you stay focused on the oath that we have taken. Stay focused on your personal responsibilities to your family and maintain your security to defend your actions. Consider your personal legal protection and choose coverage from a healthcare specialist. Quality PA Professional Insurance is important to understand, easy to get, and provides the stable and individualized protection your career demands.
By Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
PA Advisor to CM&F