I learned many things from this blog. And others could learn from Paul Levy, CEO of a hospital as well. Runningahospital blog has been voted by its readers as the best medical blog. A must read for everyone involved in health sector. Below is a blog post from the blog which i thought will be interesting for people. Hit the subscribe button if you really care.
As a non-MD, I don’t often get to attend M&M (mortality and morbidity) conferences of our various departments. These are usually highly technical sessions where doctors discuss cases that have gone awry or otherwise have educational value for the residents and attendings.
I was invited to attend one today, though, where a special guest was present, the patient who arrived in the Emergency Department and went through an incredible medical process, leading very close to death. He and his mother were at the M&M to offer the capstone comments after the medical discussion. Back to that in a minute.
This was a very challenging case. A patient with many medical problems. A difficult diagnosis. A delay in the diagnosis that probably led to “coding” and a need to resuscitate the patient. For those of you who have not been through an M&M, you would be impressed by the candor of the discussion and the lack of blame and recrimination — so that lessons from the case can be clearly identified and applied in the future.
The diagnosis was delayed because of “diagnostic anchoring,” a topic discussed in Jerry Groopman’s recent book, How Doctors Think. If you put blinders on the diagnostic path based on early indicators or predispositions, you will miss things that are important. That happened here. Luckily, though, the ultimate diagnosis was obtained in this case because the doctor in charge refused to close off other avenues of inquiry when the facts did not seem to support the initial presumption.
The successful resolution for this patient required incredible amounts of teamwork among emergency department doctors, internists, radiologists, pulmonologists, anaesthesiologists, respiratory therapists, transporters, and nurses. Here is a summary of the people and resources applied to this case.
•> 100 lab tests
•10 Electrocardiograms
•Continuous telemetry monitoring
•3 Chest X-Rays
•1 Echocardiogram
•2 Line placement procedures
•Seen by 9 physicians, 4 nurses
•Administered 12 medicationsBack to the patient, a devout Muslim, who finished the case discussion by saying that he had woken up the next morning after dreaming about the number 93. He looked out the window to see the bright sun and blue sky and realized he was dreaming about Chapter 93 of the Holy Qur’an. I quote an excerpt:
The Brightness
In the name of Allah, the Beneficent, the Merciful.
I swear by the early hours of the day,
And the night when it covers with darkness.
Your Lord has not forsaken you, nor has He become displeased,
And surely what comes after is better for you than that which has gone before.
We could certainly learn a lot from healthy discussions of the sort described in that post. The M&M meetings.
Apparently, some form of Mortality meetings were held at IGMH and MoH until middle of last year. We understand that it involved assessment and study of newborn and maternal deaths. Probably nothing much came out of the discussions! Doesn’t seem to have.
We hope that, with the increasing public awareness and willingness to openly discuss good and the non-favorable outcomes would create a precedent for the medical professionals to begin a review of their services. However, hope is something that we have had for a long time now; not much has been realized as a result of it.
The prospect of change is viewed very differently in this community, especially by the people who are in positions of power. But like the saying goes, whether we like it or not “change is the only thing constant” in this world.