Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

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.

Research Points Out The Down Side Of Chasing Success

Bill Gates once said:

Success is a lousy teacher. It seduces smart people into thinking they can’t lose.

It’s clever, and it seems right.  Now there is science to prove it.

In a study published last week, scientists studied special imaging scans of doctors’ brains as they made simulated medical decisions.  Those doctors who paid attention to their mistakes made better decisions than those who were more interested in their successes: Read more »

*This blog post was originally published at BestDoctors.com: See First Blog*

Building On The Strengths Of Your Perfectionism

I often think of the well-known expression “perfect is the enemy of good” when I am endlessly rewriting an article to make it better (when it is already good enough) and in the process just make or even miss a deadline. But this old saying also reflects the dark view many people have of perfectionism. As a personality trait, it is seen as obsessive and at times pathological. People who are perfectionists may become so focused on setting a high standard for themselves that they live their lives as if graded constantly on a report card.

But perfectionism has a bright side, too. Desirable aspects of this personality trait include conscientiousness, endurance, satisfaction with life, and the ability to cope with adversity. This helps explain why some perfectionists become corporate leaders, skilled surgeons, or Olympic champions.

Dr. Jeff Szymanski, a clinical instructor of psychology at Harvard Medical School and executive director of the International OCD Foundation, believes it is possible to become a better perfectionist—by building on the strengths of this quality and learning to minimize its drawbacks. In his new book, The Perfectionist’s Handbook, he discusses this theory in greater detail and provides exercises people can try at home. Read more »

*This blog post was originally published at Harvard Health Blog*

When Your iPhone Finishes Your Sentences

I personally find the word-completion tool kind of annoying on the iPhone – especially as a doc. The software is geared towards choosing the most common word after a few letters, and you can bet that physicians are not typing out common words. Like “emycin” is not “empty” – I’m just sayin’.

A couple of awkward ones recently – my friend was texting me about a tragic and unexpected event and I responded with “Geeze!” which (as I pressed send) turned into “Geese!” That one was hard to explain, and quite insensitive at the time. Err…

Another friend of mine was dealing with a sick kitty at home. She had taken the cat to the vet because she’d stopped eating/going to the litter box. The kitty was diagnosed with an infection and was on the road to recovery, when a couple days later she had her first bowel movement. So my friend decided to text her husband the good news via her iPhone. She typed “the cat went poo,” but alas, the iPhone had the last word. Her husband received this alarming, if not perplexing text message:

“the cat went pop”

Have you had similar iPhone drama? Do share…

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »