Blog & Articles

The discoverer of penicillin, Sir Alexander Fleming, warned many decades ago that the “public will demand [the drug and]…then will begin an era…of abuses.” His prophecy has been realized, and I readily confess that I am guilty. During my 37 years in family practice and emergency medicine, I admit that I prescribed antibiotics for viral and self-limited illnesses. There were times when I bowed to pressure from ill and desperate (but not desperately ill) patients or their parents who demanded a cure for an upper respiratory infection.

A 35-year-old female presents at 0321 by ambulance with a complaint of chest pain. The records show EMS arriving at her house and finding the patient on the couch.

Download Audio Case Review

Download as PDF

EMT Notes

Patient appears to be anxious and hyperventilating.

Is there a reliable way to predict which physician will be sued for malpractice? Researchers, insurers and healthcare professionals have wrestled with this question for decades.

A recent study in the New England Journal of Medicine and a follow-up response by the Physician Insurers Association of America (PIAA) provide more data points, but admittedly do not answer the question definitively. Perhaps they are trying to answer the wrong question.

A 78-year-old man, Mr. S, came to the emergency department with the chief complaint of abdominal pain. He was an active person, residing in the independent living section of a retirement complex. He described the pain as an ache in the mid and lower abdomen that had been present for several days. The pain did not radiate. He denied any fever, nausea, vomiting or diarrhea. He claimed having no appetite or bowel movement “for days.”

Current strides in improving patient safety in hospitals and medical facilities provide clear evidence that the healthcare industry has the capacity for meaningful change. However, providers continue to face significant obstacles; perhaps the biggest obstacle of all revolves around developing and expanding a vigorous “safety culture.” Indeed, much of the focus has been on technology and incremental process improvement, but building a “culture” is the foundational contributor to ensuring patient safety.

The practice of pediatrics is relatively unique from a risk management perspective. One study placed the risks associated with the practice of pediatrics relative to other specialties as 25^th out of 26 specialties with regard to the risk of being sued. However, although the risk of being sued is relatively low, another study found that the risk that a pediatrician may be sued in a given year was 3.1% as compared with 7.4% for all physicians.

Not all chest pain is a heart attack. While acute coronary syndrome (ACS) may be the most common serious cause of chest pain, clinicians must keep other dangerous conditions in the differential diagnosis and eliminate the possibilities based on the patient’s history, risk stratification, physical exam and diagnostic testing. One of the most dramatic and perplexing causes for acute chest pain, other than ACS, is thoracic aortic dissection.

Given that proven effective solutions exist today, why haven't more institutions implemented programs that have proven to reduce diagnostic errors?

I listened with great interest to the interview conducted by Dr. Robert Wachter with Dr. Mark Graber in the January 2016 podcast of “Perspectives on Safety,” also published in the AHRQ PSNet.

Funding a patient safety program can be challenging, especially when the return on investment is constantly under scrutiny. While the ultimate goal of your program is safer care of patients, there are also measurable financial benefits that result from reduction in claims and malpractice litigation. Professional liability carriers, whether commercial or self-insured, also have a vested interest in your patient safety measures.

Depending upon how your organization insures its HPL/MPL coverage, there are several options for funding your patient safety program.

It is certainly a good idea to avoid readmissions that are deemed unnecessary. However, from the vantage point of risk and patient safety, the sword of readmissions reduction has another sharp and dangerous edge. Plain and simple, along with sensible system solutions, there will be irrational but powerful pressures exerted on the gatekeepers of inpatient admission to send sick patients home rather than readmit them.