"You're slow. You have to be faster", this is what thousands of interns around the country probably hear daily from their residents urging them to be more efficient.Being efficient is good, being "too fast" is not.
Doctors are not the 15-minute Jiffy Lube change. It takes time to:
- review patient records
- listen to the patient to elicit proper history
- do a focused physical exam
- discuss diagnosis and treatment plan
- make sure that the patient understands them
It is hard to cram all than in 7 minutes. Something has to give.
Unfortunately this something caused a patient's death at the office of an ENT doctor in Denver, Colorado.
The doctor did not review the patient's medical records, relied only on his examination and hastily removed her tracheotomy tube. The patient became short of breath and was taken to a hospital but before doctors could reinsert the tube, she suffered respiratory arrest and brain damage, and later died.
The doctor admitted to the police that he made a serious mistake: "She did need the tube for her airway ... because she had an obstructed airway, it means she did need the tube and I made a mistake."
It is possible that the doctor was busy and his schedule was overbooked. Cutting corners can make you "too fast" which potentially may lead to tragic consequences as in this case.
My advice to the young physicians is: be "slow", take your time, do your job properly. The efficiency will come with time. Take care of your patient the way you want others to take care of you.
I still remember the recommendation letter one cardiologist wrote for a resident: "I will be happy and very confident to refer a member of my family to the care of Dr. X".
Strive to be that doctor.
References:
Doctor is arrested in breathing-tube fatality - The Denver Post
Another Criminal Charge for a Colorado Health Care Provider - Aggravated DocSurg
Advice to young doctors from members of the BMJ editorial board
Off the Fast Track 'In Praise of Slowness' - NPR 1/06
Image source: Wikipedia
Further reading:
Therapeutic Spew. FatDoctor.org, November 2, 2007.
Updated: 11/06/2007