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Newly Minted Doctors Begin Their First Jobs In July: Should You Be Afraid?

Photo By Danny Kim

The short answer, in my opinion, is yes.

The long answer is slightly more nuanced.  As it turns out, studies suggest that one’s relative risk of death is increased in teaching hospitals by about 4-12% in July. That likely represents a small, but significant uptick in avoidable errors. It has been very difficult to quantify and document error rates related to inexperience. Intuitively we all know that professionals get better at what they do with time and practice… but how bad are doctors when they start out? Probably not equally so… and just as time is the best teacher, it is also the best weeder. Young doctors with book smarts but no clinical acumen may drop out of clinical medicine after a short course of doctoring. But before they do, they may take care of you or your loved ones.

It has been argued that young trainees “don’t practice in a vacuum” but are monitored by senior physicians, pharmacists, and nurses and therefore errors are unlikely. While I agree that this oversight is necessary and worthwhile, it is ultimately insufficient. Let me provide an illustrative example.

When I was a new intern I was assigned to a patient with curious eyelids. He was a mildly obese, middle aged man with a beard who spoke in hushed tones. What struck me the most was that he had voluminous upper eyelids. They were so strange that I couldn’t stop staring at them. He didn’t have any hives or red blotches on his skin, and his eyeballs were clear and white. There was no pus or discharge of any kind. I was so perplexed that I began to search through his medical record for answers before I embarrassed myself by asking for a consult. After many hours of digging, I discovered the smoking gun.

Apparently, he had been given repeat boluses of 1 Liter of IV normal saline by dutiful interns and residents who had not communicated with one another about who would write the order. So they all did. This man was so fluid overloaded that his eyes were literally bugging out of his head. No one had noticed the edema because of his size, and because (thank God) his heart and kidneys were young and healthy enough to handle the load without going into outright failure. Also, normal saline is such an innocuous medication that it didn’t flag any concerns by the nurses (who were also rotating through the service and busy swatting the more obvious mistakes being made by the fresh crop of interns).

If this poor patient had congestive heart failure or kidney disease, he could have been killed by well-meaning, diligent interns with salt water. Fortunately for him, he made a full recovery – and because there was technically “no harm done” I don’t even think this case was discussed in M&M (morbidity and mortality) conference, and I also doubt that anyone was reprimanded. Sounds crazy, but there are bigger fish to fry in July.

So my point is this: rookie mistakes are not always tracked, documented, addressed, or perhaps even noted. But they are real. They are scary. And they are lurking at every teaching hospital in this country. We must all remain on high alert – and question everything. Because even eyelids offer important clues, and water can kill.


If you or a loved one insist on falling ill in July, I recommend finding a hospital with a culture of carefulness or bring a patient advocate with you.

Social Media And The Future Of Hospital Communications

I took care of a young lady the other day whom I admitted for  diabetic ketoacidosis.  She asked me what her bicarbonate level was.  I was a bit surprised since most of the time my DKA patients’ don’t care what their bicarb levels are.  I told her it was eight.  For the non medical types out there, that’s low.  That’s critically low.
I asked her why she wanted to know.  And before she could even get the words out, she had posted a Tweet onto her Twitter acount to update all her friends and family of her impending hospital admission.  I found that fascinating. Read more »

*This blog post was originally published at Happy Hospitalist*

Physicians, Technophobia, And Costly Communication Gaps

I was talking to a fellow physician about a mutual patient.  I had information  that would help him in their care and he was taking the unusual step of asking me for my information.  I was impressed.

“Could you fax me those documents?” he asked.  ”Here’s my fax number.”

I scrambled to get a pen to write down his number.  Then I had a thought: “I could email you those documents much easier.  Do you have an email address?”


After a long pause, he hesitantly responded, “I would rather you just fax it.”  He said no more. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

HIPAA Stifles Tech Innovation, Developing Nations Take Communications Lead

Sms_your_doctor_mexicoThis picture from 3G Doctor is remarkable.  It captures the flier of a Merck supported Mexican Medmobile initiative that apparently connects patients with their doctors via SMS (translation available on 3G Doctor Blog.)

But don’t expect fliers of this type in American offices anytime soon.  Risk of privacy violation and difficulty in documentation stifle this level of
doctor-patient connectivity.  The very laws created to protect patients may ultimately thwart the timely adoption of new communication channels.

And the slow march towards a single payer system will only make real connectivity a rare bird.

Look to the groundswell in mobile technology and social platforms will force change in our current privacy laws.  Until then look for innovation to come from the second and third world.

*This blog post was originally published at 33 Charts*

Social Media Tips For Healthcare Professionals

Whenever I talk about medical professionals using social media, people are surprised by what I say. Most people think they can hide online and never have to reveal their real identity. I think they are wrong. In the online world, it’s much easier to find out private information about someone who wasn’t cautious enough than in real life. A recent example includes Doctors warned of Facebook flirts (e-Health article):

The Medical Defence Union said it was aware of a number of cases where patients have attempted to proposition doctors by sending them an unsolicited message on Facebook or similar sites. The medical defence body said it would be “wholly inappropriate” to respond to a patient making an advance in such a way. Read more »

*This blog post was originally published at ScienceRoll*

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