There are times in many physicians' careers when they do something that they are not proud of, whether because they are overworked, overtired, or just plain burned out.
I have done a few things I am not proud of during my residency, especially during internship. There are days I allow myself to think back on it and I wince and hate myself. Thank God, nobody was ever harmed as a result. But I still hate myself, which is part of why I made sure to find a job that wouldn't put me under so much stress that I would do something stupid ever again.
I am certain I'm not the only one, so I'd like to give you a rare opportunity. If you have done something that you are not proud of during your medical training, please share it ANONYMOUSLY in the comments. Please don't reveal who you are--I don't want to know. And we get enough, like more than 20, I may share one of my own anonymously.
I think it will feel good to get it off your chest and see that we all occasionally do things we're not proud of.
This did not happen to me, but it was just luck on my part, because I made this same mistake every day.ReplyDelete
Two classmates were rotating on pediatrics, on the oncology wing. There was this little kid, I don't know exactly what he had. His parents knew about his disease and forecast, of course, but you know doctors are usually more foreboding among them than they are with patients, especially in severe diseases. So the doctor said something pretty foreboding about the kid to my mates, and they were later discussing it on the bus home. No names, of course. But the kid's mom was on that same bus, and she overheard everything. And she knew they were talking about their kid.
On the next day, she went crying to the doctor, asking about what those students had said, if it was true, if her kid had no chances to survive, etcetera.
Really, I don't know how many times I've talked about patients in public places. You never know who may overhear. I've tried to be a lot more careful ever since...
Oh my gosh, that is awful. You always think you're safe if you're not at the hospital and not talking about a patient by name.Delete
One other thing I've learned is not to say anything in front of a comatose or vegetative state patient that you wouldn't say if they were more aware. Nothing bad has every come of it in my case, but you'd be amazed how much some of them recall when they recover.
You´re right, better you shouldn´t talk about your medical stuffs when there are "normal" people around. At the beginning of my med school, we chated about our first autopsy and about appereance of corpses in a tram (you know, the first year) but there was one older guy who stopped us, because we were quiet loud. Fortunately, he was a student as well, but some people heard that and stared at us quiet dislikely... I hope there was nobody who´s spouse or friend donated his body for medics.Delete
Geez, that is pretty much my worst nightmare. I know I need to be more careful talking about patients in , even vaguely.Delete
As a family, I hope this nurse, once I raised a little dust about it, is not proud of what she did.ReplyDelete
My partner was in a medically induced coma (also on paralytics, with an open abdomen and massive sepsis), on a ventilator - and frankly, was 'circling the drain' at that point. She has recovered, thank God, but at the time, it was a close thing - everyone knew it. I'd asked, with a sign on the door, a sign over the bed, AND a big note on the front of her chart, that NO ONE discuss her prognosis or condition in the room, as I was pretty sure she was hearing parts of it, at least, and didn't want to give her any reason to give up. Everyone had been really good about it, except this one nurse.
She came in one afternoon, asking me "well, I think we need to start talking about end of life decisions. Have you decided when you'd like to remove life support? Has hospice talked to you yet?" This is while she's both brand new on shift, for the first time with my partner, and hasn't even introduced herself! She acted like she was ready to pull the plug before her dinner break. I nearly hit her, I'm embarrassed to admit - I've never actually hit someone, but she would have been the first!
I all but dragged her off to the charge nurse, who had someone else switch patients with her so that I wouldn't have to deal with her again. Being frank with the family is one thing, but casually asking when you're going to pull the plug on your spouse? Oh, no. Not acceptable.
That is really bad! Yikes!Delete
But we can all easily come up with tons of stories about bad things that doctors or nurses have done. I want to hear from the medical people themselves, with stories of what they remember from their own career as something they truly regret and feel remorse for.
That is a hard one, I can say from a "legal" stand point all of my "regrets" are over 7 years old, but that does not make it any easier to admit or think about, even as an anon on someone elses web space.Delete
I think admitting them as an anon on someone else's webspace might be a good way to get things off your chest without any risk.Delete
When we had to do a nursing internship, I was on pediatric cardiology, and there was this kid s/p "easy" heart surgery ( I think it was an ASD closure), just came from the ICU to the normal ward, and he was on diuretics.ReplyDelete
The parents asked about why he peed so much and I told them it was because of the diuretics - to relieve the body from the overload of water. Or something like that. I was just a first year student, no authority whatsoever, but for some reason they understood this as a request to give him as little water as possible. So on the next day (or maybe it was after a weekend), he was almost dehydrated, and very constipated! Poor little guy.
I apologized profusely to the parents, but I still felt very bad.
Well, but you didn´t say don´t give him water... Sorry, but normal parents should know that.Delete
here is mine: http://happyinternist.blogspot.com/2011/04/i-make-big-mistake.html (sorry, don't know how to put this in as a link...)ReplyDelete
This is an interesting TED talk about the culture of shame and denial surrounding mistakes in medicine. He makes some good points, especially about how by being unable to comminicate about our errors and near misses we miss out on valuable learning opportunities.
Yes, but these aren't all *mistakes*. Doctors sometimes do things willfully that they know are wrong. Talking about a patient in a public place isn't an "accident" like mixing up two patients' charts.Delete
Once when I was pregnant and having pretty bad ongoing nausea and vomiting, I was on call in the PICU. I found out that we were getting an ECMO admit, and I had never had one before. The unit was already packed, I was terrified and miserable and nauseous, but I probably could have sucked it up and stayed. I didn't. I called in backup. I'm really sorry backup person.ReplyDelete
Another time I told a family on the phone that their kid was getting an LP and they came rushing in: turns out I had told them about a different patient, not theirs, who was a normal kid s/p tonsillectomy.
This feels good!
We had an incidence when I was on peds where the mom got a phone call telling her her kid had cancer. The caller used the right name and everything (so I'm baffled as to how this could have been done). Turns out, the kid who had previously been in the room had been transferred to the Heme/Onc floor and was waiting for the results of the biopsy. The mom was very relieved that her kid did not actually have cancer.Delete
(I'm a nurse). Once I came on shift at 7a and had (in addition to my other 3 patients) two older black men, both accompanied by their wives, in side by side rooms, with similar dx, with the same initials and very similar last last names, both scheduled for invasive diagnostic procedures around 9.ReplyDelete
In the midst off phone calls from scheduling, doctors, and what not I somehow got the consent papers backwards, so I had the patients consenting for the wrong procedures! One man's wife had looked over the papers and asked me about the procedure but when I assured her that everything was in order she just signed it. I felt terrible!
Fortunately I discovered the mistake in with time to make new copies and get the correct consents signed. I don't think there was ever any danger of the men actually undergoing the wrong procedures, but it could have made for a bad start to the day for a lot of people besides me.
I've given incorrect doses of medication before. It's always been minor mistakes in my case, but I know I am not the only one. I have personally heard first hand of 10 fold incorrect doses being given accidentally! Doctors aren't the only ones who make mistakes.
This is a helpful thread to read as a 2nd year med student. At a recent practical experience, one of our teachers asked us what our greatest fear in medicine is, and most of us said it is accidentally harming a patient. I know it's natural and human to make mistakes, but most of us think our attending physicians are infallible. Thank you for sharing your stories!ReplyDelete
As a resident I got a call about a patient who was agitated and the nurse asked if we could give Ativan. I said yes. But we'd just had a lecture where we were told to always eval an agitated pt. I didn't because it was 3am. He turned out to be in heart failure. He ended up fine but I felt so so guilty about it.ReplyDelete
As a resident, I was supposed to have a couple 10 ml tubes of blood sent on a baby with cardiac disease who was dying and the blood would be used for genetics to help the parents with future pregnancies. I kept trying to find the right time to ask the nurse b/c they were really busy trying to resuscitate the baby, and it was a massive amount of blood for the child. The baby passed away before we could get it sent, and I felt terrible. I ended up crying for a couple days, told my attending what had happened, and felt like it was potentially such a huge miss for these poor parents. My attending thought I was totally overreacting, but I still felt horrid.ReplyDelete
I was an intern on ICU.ReplyDelete
There was a patient who had been on the unit forever, she was awake but was having respiratory support of some sort (it's a while ago); anyway, after changing one of her lines, I was going to suture it in place and presuming she was like all the other ICU patients, just stuck a suture needle in her.
She could move but she gave me an evil stare. I apologized !!
Said procedure was repeated with Lidocaine.
These are some good stories, but I think you could do better. Where are all the evil cover-ups? The times when you lied and said you saw a patient but you really didn't because you were so crazy busy and as a result missed some critical finding? (This happened to an intern I worked with--not me!)ReplyDelete
I once had a patient in the ICU after being over-sedated from a rather routine procedure. He had had a CT that had incidentally shown a mass (likely metastatic) in his heart. I was the intern on, and at like 8 pm my attending told me to discharge him to home. I failed to mention this mass in my discharge summary. He was supposed to follow up with his PCP and didn't. He came in a few months later in cardiac arrest and was declared brain dead. Still not over that one and it was a good year ago.ReplyDelete
I was consenting a woman for delivery of her baby.ReplyDelete
In the section labeled "alternatives to this procedure" I thought: aside from a delivery with an OB, what are the alternatives?
I wrote you could "deliver with a midwife, delivery in L&D Triage, deliver in the parking lot, etc." I was trying to think of ALL the possibilities at that point -- and got chewed out for my idiocy. In being thorough, it might have come off as completely flippant.
Now I know to avoid the "crazy scenarios" option and go only with MEDICAL alternatives.
I think it was the "etc." that was the kicker.
In my first couple of weeks of internship I had a patient who'd had cauterization of angiodysplasia in the caecum due to bleeding. When I rewrote her med chart I forgot to put a hold on her clopidogrel so it was given to her. She started bleeding again and ended up getting taken to theatre for a right hemicolectomy, having already had a left hemi. I felt REALLY bad about that.ReplyDelete
Surprisingly nobody in the surgical unit ever mentioned it to me again. They knew about the stuff-up but it just wasn't ever discussed. I hesitate to say it was swept under the carpet - but that's what it felt like.
A patient in ICU was experiencing a complication. She went from sitting up, eating dinner, to tachy and hypotensive in the space of a few minutes. While trying to figure out what was wrong, she looked at me (the RN) and asked if she was going to die. I looked her right in the eye and said, "No."ReplyDelete
She died about 30 minutes later despite all of our very aggressive resus attempts.
I was evaluating a patient for a foot infection and he mentioned having some hip pain so I ordered an xray. I also ordered an ultrasound which showed enlarged lymph nodes and his hip pain got better after he was on antibiotics so I figured it was just swollen lymph nodes and forgot about it.ReplyDelete
A week later the xray report showed up in my hospital inbox. Lytic lesions consistent with metastatic cancer.
The worst part of all of this is, I asked a different resident to please tell the attending for me because i felt so bad. The patient had been discharged by that point and never followed up, so he's walking around with metastatic cancer and doesn't know it.
I once took care of a patient who got a similar xray for hip pain, showed lytic lesions, and everyone including me was convinced she had cancer in her bone, and we told this young woman she had cancer.Delete
She had an open biopsy showing chronic osteomyelitis instead of cancer, and she was the happiest I'd ever seen anyone at the moment they get told they have chronic osteomyelitis.
My point is that maybe your patient actually had chronic osteomyelitis, too, and the antibiotics did, in fact, make her better.
I lie on report card comments. It's better to protect myself and the kids (some of the parents are really aggressive) and just be positive. Sure, everything is fine and dandy.ReplyDelete
I am guilty of false reassurance.ReplyDelete
An extremely anxious woman with breast cancer, stage III B, asked me if she was going to die, I told her that these days, breast cancer was like diabetes, many treatments, long and painful, but treatments nonetheless.
I am also guilty of wrong dosage, but an awesome nurse saved the patient and my a**
The time I was not so lucky, I started steroids on patient with MS, rather exuberantly, and she had the most memorable acute episode of psychosis - she was a goddess with supernatural powers in a general medical ward..... her hair flew magnificently as she hopped from bed to bed
I will submit anonymously. I am an RN. A few years ago I was working on a bone marrow transplant floor, night shift. I was taking care of a 40 something year old patient with AML who had already had his transplant but still had circulating blasts- very poor prognosis. At some point very, very late in my shift, I realized that the continuous infusion cyclosporine was not running. The nurse on the previous shift had hung a new bottle, but never hit "START" and how the hell I missed this I will never know, as I was known for being very meticulous. It had been off, I estimated at the time, for about 10 hours. I decided not to say anything, and used his crappy prognosis to rationalize my crappy choice.ReplyDelete
The patient died about a week and a half later and while his death was expected because his disease was quite out of control, that he died with the most God awful case of graft v. host disease was quite unexpected. He suffered. I still feel awful about it.
Wow. That's an incredible story. Thank you for sharing.Delete
I was a student and it was my last week of a rotation in a General Surgery War. I had deeply enjoyed my time in the OR through the rotation... I had had medical training in another country and this was the first experience where they had let me scrub, so I was in the OR any time the Attending asked me. As my rotation drew to a close I was expecting to be unable to have first-hand experience in an OR for a long time, so I didn't want to miss anything.ReplyDelete
On the last day of my rotation I had this awful cold, I couldn't stay without blowing my nose for more than a minute or so, it was really bad. But it was the LAST day and I didn't want to stay home and call in sick. So I went to the Ward, and the Attending asked me if I wanted to scrub.
I answered that I would have loved to (without mentioning my cold), and proceeded to stuff my nostrils with some sort of self-made nasal tampon, put my mask on and scrubbed.
It wasn't a long procedure, but after an hour or so without blowing my nose I noticed that my "nasal tampons" weren't holding the rhinorrhea anymore, and the fluid started to accumulate inside the mask. I panicked, I did not know what to do. I felt one drop of the liquid leaking from the mask and saw it fall on the sterile camp. I STILL didn't say anything. The procedure was almost over, and I pretended that nothing was wrong, never leaned in again (I awkwardly leaned back instead) and the next day I left without telling anybody.
I did that too once. I started crying and a tear dropped into the sterile field. No one noticed and I didn't want to draw attention to me crying so I kept my mouth shut and continued crying silently.Delete
Silent crying. A useful skill of the surgery resident.
I once yelled at a drug-addicted 21 year old in the ER who was being an obnoxious kid during his admission H&P, giving vague answers and refusing to answer and whatnot. His mother was outside and called me on it, and I did feel bad, but at the time I was just really pissed off that this brat was taking up my time at 3 am with what I saw as a bogus admit. It was not hte finest example to set for my intern, for sure.ReplyDelete
I was checking labs on a patient and the labs for that day weren't in yet, but I thought the labs from the day before were current, so I wrote those down and reported them to the team. The next day, that patient had a fever, and a day later, she went into septic shock and died.ReplyDelete
It turns out the labs I missed from that day showed an elevated white count. Maybe if I had noticed it, we would have started antibiotics earlier but I don't know for sure. She was pretty ill and probably still would have died, but we can't be sure.
My senior resident was the one who pointed out my mistake to me, and neither of us ever mentioned it to anyone else.
I remember an Attending coming in for late rounds after his clinic hours. It was probably after 8 PM. We had a patient on service with really bad lung disease. The attending listened to his lungs for a minute, and looked at a Chest X-ray. He patted the guy on the back, turned around to the team and announced this man is going to need a lung transplant. He then left the room, leaving the patient dumbfounded. No compassion, just cold hard fact.ReplyDelete
In ED I saw a woman with chest pain.ReplyDelete
It was chronic, sounded very msculoskeletal but I still ordered bloods, ECG and CXR.
The dept was very busy and she waited for a while.
I went to tell her the results of the bloods (which were normal) and to discharge her home when she told me she hadn't had her CXR yet.
I told her that we changed our minds and decided it wasn't warranted.
I feel bad about this all the time though it was years ago.
I can tell when my students don't check things and usually call them on it. Such as a note saying "liver normal" when it's obviously hugely enormous and anyone can feel it. I've learned early on that it's just embarrassing to miss something but pretend that you checked. So if I don't check, I don't write it down.ReplyDelete
I did miss a blown pupil once. Neurosurgery picked it up a couple hours later. The patient ended up dying. Others missed the pupil, too, and I was a student at the time, but I still felt badly - would the extra few hours between me and neurosurgery have made a difference? I doubt, but what if...?
Also, something we ALL do - check the fundi and pretend like we know what we're looking at. I have seen pale, small, large and swollen fundi and I cannot see the difference. I doubt many others can, too. So we write "fundoscopic exam normal". I've stopped that, too.
I myself have not done anything intentionally bad. I force myself out of bed to check on a patient, or accumulate a list of 2-3 to see (if they're benign requests). I've definitely intentionally waited 2-3 hours for fuzzy consults, and those usually go away on their own.
We HAVE intentionally avoided rounding on people we didn't want to see until they were off the ward or bathroom or whatever. In that case, we just relied on nurse reports for vitals. Or sent in th medstudent so s/he could get stuck in the room for two hours while we got work done.
I, too, subscribe to the "don't write it down if I didn't check it" policy. Better to have an incomplete exam documented than lie about what you did or did not see/do. Also helps me to be more complete more of the time as I hate how I feel when I realize I forgot to check something I consider relevant to a given patient.Delete
I submit that students (well, some) are just so bad at physical exam skills that things that seem blaringly obvious to you aren't to the med student. There have honestly been times when I've thought a specific aspect of an exam was normal, and the attending (or resident) disagreed with me and pointed it out. It wasn't that I didn't check, just that I'm horrible at physical exam skills.Delete
Yeah, and even if you notice a physical exam finding, you may forget about it in the time it takes between your exam and writing your note. This is especially frustrating when you're dictating and there isn't an easy way to immediately correct it. I don't think this is necessarily shameful, just a normal human error.Delete
Oh my goodness, dictating is just ... Ugh. I'll remember everything just before starting, collect my thoughts, write down important points, and STILL forget. Then it starts "um please add addendum - pt height and weight were.. Oh and so please add the name- no wait- uh- I should maybe spell this- oh crap" and just start over.Delete
I was a new Rn in the ED. A patient arrived via EMS with complaints of a cough and horrible shoulder pain. In my assessment, he displayed all the classic signs of a AAA, including a large pulsatile mass in his abdomen. I let the ER doc know what I thought I had when I handed him the chart. This particular doctor was known to hate his job, hated being in the ER and acted horribly toward nurses. I tried not to ever talk to him.ReplyDelete
I completed all the orders except the ultrasound wasn't done. We were still waiting for them to come. The doc admitted the patient to the ICU and wanted him to get out of the ER. I truly believed that if the U/S was done, the guy would be taken to the OR right away. I approached the doctor to tell him about the delay in the ultrasound, but before I did he flipped his pen in the air and yelled at me to get the patient upstairs. I was afraid to say anything else to him.
I really, really felt that he needed it done before going up. I'm not a doctor, but I know when I feel something is wrong with the patient.
The patient was transferred to the ICU, I placed him in his bed. He started coughing and vomiting uncontrollably and then coded.
I felt horrible that I didn't go with my gut feeling and advocate for him because of my fear of this doctor. It's been years since this has happened and I still feel regretful.
I will never do that again.
Wow, that sucks. But you have to figure that in the time it took to get him the US, then get him prepped for the OR, he would have coded anyway.Delete
I know. But it's the "what ifs" that truly drive me crazy.ReplyDelete
Live and learn, right?
I'm an RN with 35+ years experience, in various areas. I live with many memories, good and bad. Three still haunt me 20+ years later.ReplyDelete
Had a patient in the CCU with dilated cardiomyopathy. He was awaiting a transplant on an IABP and was incredibly unstable. He had run out of IV lines/ports for all his various meds, and I chose to stop his lidocaine drip for 20 minutes to run in the antibiotic. The choice seemed reasonable at the time. He went into VT arrest that deteriorated into VF. It took us a good 20 minutes to get organized cardiac rhythm back. He lived to get his transplant but he was never the same after that arrest.
One evening I was the charge nurse in that same CCU. Fellow nurse and resident admitted a lady with a large involved family. She had had an enormous MI; I don't remember the details. I do remember the nurse and I and the resident worked quite hard to get her stable. Her family was talking with the other nurse & resident about how much Mom loved her independence and how they hoped this "heart attack" wasn't going to change her. We had already had evidence from ABGs and seizure activity that it was unlikely Mom was going to survive the bomb that had gone off in her coronaries and heart muscle.
The nurse and the resident reassured family and then sent them home. About 20 minutes later I was watching the central monitor and saw the pt's QRS widen way out. I jumped up and ran into her room. The resident and the nurse had turned the ventilator off and had unhooked it from her ETT.
They just looked at me. I looked at them.
I walked out of the room, and turned off the central monitor screen.
And I never said anything about this experience until today.