Most of us have seen the movie, Fatal Attraction, and are aware of the potential fallout of misguided judgment. For my first article of 2024, I wish to examine the complications of making assumptions. They can endanger our patients, potentially destroy our professional reputations, and bring litigation to our employers as well as ourselves.
A friend recently underwent an upper endoscopy as an outpatient in gastrointestinal practice. While some may say this is a minor procedure with minimal complications, the truth is that there are no minor procedures, but, rather, minor clinicians and there exists the potential for an unfavorable result in any procedure. The first take home point is that we, as clinicians, should refrain from using the expression “minor procedure.”
Fortunately, my friend had a successful procedure, but it was that which followed which became a cause for concern, unnecessary anxiety, and a potential judgment on this practice. There was faulty communication or, more explicitly, no communication for almost three weeks. Considering that the procedure was done, in part, to rule out cancer in a survivor, one would expect the health care team to respond as soon as pathology results were in. And the, albeit unfortunate, ageist assumption would be that a 68-year-old may not be computer savvy enough to access a patient portal. My friend was able to do so. But as a layperson, she had no way to decode the complex pathology report or standard op report. An operative note and a pathological diagnosis are almost meaningless to most patients and a more appropriate dictated letter explaining the diagnosis and treatment plan in a patient’s language is far more appropriate and simultaneously causes relief from misconceptions of a keyword or a “no news is bad news” interpretation from the patient. Never, never ever, state that if you do not hear from us then “everything’s fine.” Hearing nothing does not mean that nothing is wrong!
According to a Johns Hopkins Study, there are more than 250,000 preventable medical errors that ended in the death of a patient, every year. This is the third leading cause of death in the United States after heart disease and cancer. According to Issues in Healthcare today, preventable medical errors are first on the list. Here exists an algorithm that experienced attorneys utilize that can pinpoint this type of problem and they can follow it like the bread pieces that Hansel and Gretal dropped. However, unlike the fairy tale, our errors cannot be eaten by the birds or erased by the clinician, because of EMR utilization.
When we think of medical errors, we most often reference a medication error, or leaving a sponge in an operative patient. But the failure of appropriate communication is at the root of many crises, both personal and legal. My friend, luckily, has many friends in health care, so she was able to alleviate her abject anxiety without waiting for a contact from her physician’s office. So, she waited for three weeks. They obviously failed her test of whether she exists as a valued recipient of their care.
Even communicating via electronic charts requires more diligence than our busy time often allows. Importing canned advice can be a time saver but is also fraught with ways to fail in our rapport with our patients. Including recommendations that are not remotely pertinent: “lose weight and exercise” to an already fit and thin individual. Or importing info with the wrong gender pronouns. These oversights do not build the relationship with your patient that is essential. A solid rapport often eliminates an adversarial posture, even in the face of other errors or oversights. And communicating with your patient through a My Chart is not helpful if it makes them feel invisible.
Wrong assumptions are immediately repudiated when the assumption is illuminated by fact and the medical record. An assumption is an idea that is accepted to be truth without certainty. Assumptions in the practice of medicine and nursing can lead to the wrong diagnosis, the wrong treatment, and a ruined reputation. Reaching a diagnosis is a journey with many detours and unrecorded roads that sometimes fail to allow the person to be aware of a destroyed bridge. The outcome can be death. This is why we need to review every chart and history, particularly drug allergies, before starting a treatment and consider a differential diagnosis.
In my experience of being a PA for forty-seven years, one cannot ever assume that everyone reads and comprehends your findings and their potential treatment. Modern medicine utilizes scribes and secretaries and other lesser trained personnel to make these decisions as to what was or is important, and they simply lack the training to properly understand the mitigating circumstances. If a team member has a full understanding of their responsibilities and the potential dangers of their actions both for the patient and the treating clinician, they would in all probability relieve themselves from this responsibility rather than allow their ego to create a catastrophe.
As we enter this new year, why not make a New Year’s resolution to not only “do no harm” but to refrain from assumptions that can bring our career to a standstill. Two things other than failing to assume are important: one is to realize that your reputation is your acceptance from both your employer and your patient, followed by the fact that only a superior rated malpractice policy has the potential to provide your best defense and it’s tax deductible for 2024.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor