Halifax Medical Malpractice Lawyer Blog

Dangers of Deprivation

The Canadian Medical Association Journal has published an editorial that suggests that sleep deprivation in doctors is endangering patient safety.

According to the authors of the editorial, Drs. Noni MacDonald, Paul Hébert, Ken Flegel and Matthew Stanbrook: "The problem may only be getting worse..."

Last year, researchers reported higher rates of surgical complications if a surgeon had less than six hours of sleep the night before.

Doctors Partly to Blame?

"We doctors ourselves are part of this problem...We need to shift our professional culture. Long periods on call should not be accepted as routine or a source of pride. Instead, we must admit that working while impaired from sleep deprivation is neither normal nor acceptable."

What Do You Think?

Does Doc + Sleepy = Dopey (or danger)?

+ = ?

A diagnostic error, or misdiagnosis, happens when a doctor (or other health care professional) reaches an incorrect conclusion about what is wrong with you.

In Canada up to 7.5% of patients experience some form of diagnostic error.

Why Diagnostic Errors Happen

There are many reasons why diagnostic errors can happen including:

Lack of information: Sometimes patients do not provide a complete or accurate medical history. If a doctor is not aware of significant signs or symptoms that the patient is suffering from they may not be able to accurately diagnose the patient’s problem.

Multiple doctors: When a patient is treated by several different doctors there may be problems with communicating information between health care professionals. When each doctor has one piece of the puzzle and they don’t all communicate to put the pieces together then diagnostic errors can occur.

Diagnostic inertia: If one doctor doesn't conduct a thorough examination and create a complete differential diagnosis list other doctors may follow the same incorrect path created by the initial misdiagnosis.

Failure to order or follow-up on test results: If a doctor fails to order an appropriate test or follow-up on the results of tests that they have ordered, patient safety can be jeopardized.

An Example

In one case we were involved in the emergency room doctor ordered blood tests on my client. The test results (that came back about an hour after my client was discharged from the emergency room) showed that he had a severe infection. The doctor did not notify the patient. The infection advanced to the point where it caused an abscess to my client’s spine and he became paralyzed.

10 Tips to Prevent Diagnostic Errors

1. After your doctor examines you ask for their “differential diagnosis”. Ask your doctor for the condition or conditions that they suspect and the reasons for their diagnosis.

2. Alternatives: Ask your doctor if there are any other reasonable alternative diagnosis for the signs and symptoms that you are suffering from.

3. Get an advocate: Many people are not comfortable questioning their doctor. Ask a family member or a friend to attend your examinations and take notes.

4. Make a list: Create a list of all of your symptoms. Go from the top of your head down to your toes and list all of the problems, signs and symptoms that you are concerned about. Record the time of day that the symptoms occurred and how long they lasted. Provide this information to your doctors when they examine you.

5. Medical history: If you see a doctor for the first time, write down a brief medical history including any past medical problems, any medications that you are taking, any allergies and any past medical conditions or surgeries.

6. Follow-up: Many diagnostic errors happen because tests are ordered but the doctor fails to read the test results when they are completed. If you are in the hospital ask your doctor for the results of your tests. If your family doctor has ordered tests, call back and ask for copies of the test results.

7. Google is your friend: After your doctor tells you their diagnosis, research the condition online so you know what signs and symptoms to look for.

8. Get a second opinion: You are entitled to ask your doctor for a second opinion. If you are not comfortable doing this ask a friend or family member to advocate for you.

9. Repeat tests: If you are still concerned about your ongoing symptoms ask your doctor to repeat the diagnostic tests.

10. Communication: The most important way to prevent diagnostic errors is to make sure there is full and open communication between you and your doctors. Tell your doctor about any questions or concerns that you have.

Nobody knows your body better then you do and the more information you are able to provide your doctor, the better he or she will be able to accurately diagnose your illness.

Continue reading " Patient Safety: 10 Tips to Prevent Diagnostic Errors " »

The Canadian Patient Safety Institute, a non-profit organization, has created a new website designed to provide the public and health care providers with patient safety information from around the world.

The website is located at www.patientsafetyinstitute.ca

The goal of the website is to provide access to safety advisories, alerts and other resources as well as to allow users to share information to help enhance patient care and protection.

The CEO of the Patient Safety Institute, Hugh McLeod stated:

“In a meeting with the VP of a busy hospital, I asked what is the one tool we could provide you with that would make access to patient safety information easier. Her answer to me was to have access to one website that would provide all information you need to know about hand hygiene, medication safety or any other patient safety and quality focus. We took the idea to heart and have spent the last 7 months building the improving care search centre.”

This is a tremendous initiative and I would urge everybody to login to and bookmark the Patient Safety Institute website.

Quebec became the first province in Canada to require hospitals to publicly disclose medical errors. Quebec’s Department of Health and Social Services has announced a new registry that will collect standardized data from 275 hospitals across the province.

The system will document all reported medical errors including:

1. Patient falls;
2. Supply problems; and
3. Medical record errors.

Incomprehensible Delay

The registry is being implemented 9 years after Quebec passed a law requiring hospitals to track “adverse events”. The goal of the legislation is to identify and correct any patterns of medical errors.

Jean Pierre Menard a medical malpractice lawyer from Montreal calls the almost 10 year delay in implementing the legislation “incomprehensible”.

First Step

As I mentioned in previous posts, until now, there has been no law requiring doctors of hospitals to disclose medical errors. This initiative by Quebec is an admirable first step in improving patient safety and consumer’s confidence in our health care system.

One Down Twelve to Go

Now that Quebec has made reporting hospital errors mandatory there are “only” nine more provinces and three territories that need to implement similar legislation.

What are they waiting for?

Continue reading " Quebec Orders Hospitals to Disclose Medical Errors " »

Doctors are still doing everything they can to prevent patients from posting negative comments on doctor ratings websites like Rate MDs.

I have discussed how some doctors in the United States require patients to sign a contract agreeing not to post negative comments about the doctor online before the doctor will agree to treat the patient: Doctors Forcing Patients to Sign Gag Orders.

One doctor sued her own patient for posting a negative review of the care provided by the doctor:Doctor Sues to Silence Patient .

Public Relations Problem

I think we can all agree that suing your own patient is a bit of a public relations problem for doctors who want to be seen as sympathetic and caring.

Becoming More Creative

It appears that some physicians are becoming a little more subtle in their efforts to manage their online reputations. Yesterday CBC reported that some doctors are requiring patients to sign an agreement that transfers the copyright (ownership) to the doctor for any comments posted by a patient about the doctor. Very clever.

Doctor Controls Patients Comments

Under such an arrangement, patients can are free to post reviews online. If the doctor likes what their patient says about them, presumably they will allow the commnets to remain online. But if a patient posts any negative comments, since the doctor owns the copyright to the comments, the doctor can contact the website and request that the comments be deleted.

Fighting a Losing Battle

I think the genie is out of the bottle on this. The internet simply provides too much opportunity for the free and open exchange of information. Doctors (and lawyers and other professionals) need to face that fact and treat their patients (and clients and customers) accordingly.

What do you think?