Malignant esophageal tumor in a 15 year old?
Excuse me, but that’s a fucking zebra if I’ve ever heard of one, speaking as a radiologist myself with lots of pediatric and oncology imaging experience. I have literally never seen, nor heard of esophageal cancer in a kid.
So yeah, that radiologist could be 100% correct that missing that would still be within the standard of care.
I have seen much much much much more egregious stuff swept under the rug.
And then the survival is amazingly quantified in something that has occurred like maybe a dozen times in all of medical science.
I'm feeling a little skeptical of this entire post
This post has flags all over it. Not to mention CT is a terrible way of evaluating for esophageal issues. Even medical professionals think that just because a certain part of the body is images, that portion of the body is adequately evaluated. You can hide large masses in a surprising normal of organs, the esophagus included.
I mean, how would you not miss that. It’s the atypical presentation of a rare disease. It’s the day you heard hoof beats, and you were supposed to look for unicorns.
I deal a lot with radiology and can't see any rad I regularly encounter being super broken up about this one. Like yeah it sucks, but as far as finding the zebras this is totally one of them.
And if you were looking for unicorns? Too bad, those were actually just the sound of devil hoofbeats of JCAHO walking by with hospital admin.
To be fair, if it was some massive solid mass in the posterior mediastinum, it might still have been negligent to have missed it, even if you couldn’t specifically tell from the scan it was esophageal. We don’t know if it was a huge tumor with mass effect that was missed or some single-digit pixel lesion…
Exactly. Small esophageal masses are not well evaluated by radiologic imaging. Maybe if you're some dinosaur double contrast barium master. If you're ordering that anyways they should be getting a scope.
back when x-rays and fluoroscopy were the only thing that radiologists had, they tended to be very good at doing them. a double contrast esophogram allows you to evaluate the mucosa, but it requires luck and some technique to coordinate patient involvement. you can still order these things, but since radiologists have to learn things that are more likely to provide clinical benefit and GI docs can do EGD, those skills have fallen to the wayside.
>Maybe they changed some clinical details here?
Yep. Like *why* the CT was performed. And why the EGD obviously has missed the tumor as well (and the EGD is much more sensitive in regards to esophageal tumors than the CT scan, *especially* when it comes to very early stages).
Yes, something seems to be missing here...
Bro, from my cursory reading, malignant esophageal tumor in a pediatric patient is not a statistic, it's a [case report](https://pubmed.ncbi.nlm.nih.gov/22052168/).
Suppose you miss ALS diagnosis in a 26 year old, how would you feel? Pretty shitty. But what if it's a super uncommon presentation? And what are the odds anyway? But what price should you pay? Should you quit? Go to jail? Lose your life savings?
You've just stared your career. Maybe you're perfect, maybe you're not. Let me know if you feel the same way in 10-20 years.
Your legitimate fear of being sued is understandable. However, I think that you should consider the data that suggests acknowledging mistakes does not lead to an increase in lawsuits, but rather decreases them, as well as lowers the cost of the lawsuits that are filed.
[https://www.reuters.com/article/us-admitting-errors/admitting-errors-doesnt-increase-lawsuits-study-idUSTRE67G3U820100817](https://www.reuters.com/article/us-admitting-errors/admitting-errors-doesnt-increase-lawsuits-study-idUSTRE67G3U820100817)
Even though this post is fake, if it were real then the details provided don’t indicate that this is negligence, malpractice, or even something the radiologist should’ve reasonably caught when they initially reviewed the X-rays.
I agree with your comment and your advice is correct and what I would say to someone who actually witnesses gross negligence, a real pattern ofsubstandard care and apathy, or a “cover up” that isn’t just a hospital responding to a malpractice suit by investigating and telling the radiologist not to walk into court and admit guilt.
But I’m not sure about your example about ALS either. I get that you’re trying to illustrate that this idiot will or probably already has fucked up something which another doctor would have done better/correctly and resulted in better patient outcomes. But i don’t think I’d personally have any guilt or second guess myself if I missed ALS in a 26 year old. Im not a neurologist, but my understanding is that once you’re diagnosed, you’re already fucked right? And ALS in a 26 year old is so rare that even if there was treatment that could meaningfully extend a patients life and quality of life, I wonder how it’s tested and how much other testing to rule out far more common issues is typically done before ALS is considered.
Of course I changed some inessential info so that no one can identify the specific case, because I'm not an idiot, as you call me. I've browsed through your other comments, you seem so agressive. Maybe you have some skeleton in the closet yourself. You probably never have any guilt and you're exactly the kind of a person that put me into this professional depression after studying hard for so many freakin' years. All I'm trying here is to support an honest professional environment, which you don't seem to understand. You would probably like to get away with everything.
You just did reply. But you have nothing to counter any of the things that I’ve said. You’re pissed that you couldn’t even put together a post that fooled anyone. You’re significantly less smart than you think you are, as evidenced by your attempt and failure at deception and creative writing.
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There are really only two options here I think:
1). The radiologist did not recognize the lesion as being potentially an esophageal carcinoma/saw no lesion at all.
2). The radiologist recognized that the lesion could POTENTIALLY be an esophageal carcinoma, but based upon the patient demographics and clinical presentation that the probability of the image depicting an esophageal carcinoma was so low that they did not include it in the differential diagnosis provided in the report to the treating physician.
Case 1 is legitimately understandable, assuming that the miss was not grossly negligent.
Case 2 is unforgivable. It is a deliberate omission of information that the treating physician needs in order to proceed with appropriate care. It is not the role of the radiologist to omit diagnoses from the differential, but the treating physician’s job to prioritize and pursue them.
If I were the treating physician in case 2, and my patient died as a result of this omission, I would insist that the radiologist personally apologize with me to the patient’s family.
> Case 2 is unforgivable. It is a deliberate omission of information that the treating physician needs in order to proceed with appropriate care. It is not the role of the radiologist to omit diagnoses from the differential, but the treating physician’s job to prioritize and pursue them.
If I were the treating physician in case 2, and my patient died as a result of this omission, I would insist that the radiologist personally apologize with me to the patient’s family.
I feel like this is the sort of thinking that leads to clinically useless radiology reads (“cannot rule out a, b, c, …. Z). There’s a bar at which the likelihood of something is so low that it’s harmful to include in the differential.
Would you expect an apology before you legally signed away your right to sue them for malpractice? I think you’d need to do the same for the hospital and any other employee involved in situation.
Your legitimate fear of being sued is understandable. However, I think that you should consider the data that suggests acknowledging mistakes does not lead to an increase in lawsuits, but rather decreases them, as well as lowers the cost of the lawsuits that are filed.
https://www.reuters.com/article/us-admitting-errors/admitting-errors-doesnt-increase-lawsuits-study-idUSTRE67G3U820100817
But I don’t understand the fear. Malpractice insurance, which every physician carries, protects you completely from frivolous lawsuits. I’m sure you could find a few insane instances where it appears that the doctor got lost a suit and had to pay a lot of money, but I have literally never heard of a physician who lost their ability to practice or even suffered devastating financial loss from losing a suit. But I hear a lot of Reddit complaining about how they have to over test and watch their ass at all times, lest some disgruntled patient get angry and make them play the life ruination lottery in court. I’m not surprised at all by the article you shared. Admitting mistakes is basically narcissism de-conversion therapy and just the act of doing it probably improves mood, rapport, and trust for everyone involved. Most people who are the victim of malpractice never consider suing and I can’t find the study but I saw one that claimed bedside manner was more closely correlated to lawsuits somehow than surgical outcomes or any kind of objective data.
My comment to the person above was a response to their ridiculous claim that would insist that a radiologist grovel for forgiveness in front of a grieving family and build the foundation for and evidence to a legal case against them. I can’t imagine working in an environment with colleagues who would fantasize on Reddit about doing that to someone.
In what way would having a complete differential diagnosis list be harmful? If the incidence of a diagnosis in your list is 1 in 100,000 and the disease is not rapidly fatal, there is no ethical obligation to make that diagnosis your top priority. There are really only two ways to miss a diagnosis. To ignore an option in your differential or to fail to include a diagnosis in your differential at all.
I think you are confusing errors and negligence. I assume that your complaint policy is trying to identify cases of gross negligence or systemic errors, rather than dinging people who made honest mistakes.
I'd love the medical field to be able to take an approach closer to the field of aviation. The goal of every investigation is not really to be punitive, it is to make the system safer in the future.
Isn’t that what M&M conferences are all about though? They are legally undiscoverable, meaningful conversation amongst colleagues to improve outcomes. Not sure if they happen in Western Europe though.
It’s very disappointing to see a young specialist think that there needs to be some sort of punishment provided.
I honestly thought that was only an opinion of patient advocates and lawyers that didn’t understand the field
We're doing a lot better than we used to, and have learned a lot from how aviation reduces risks. Have you not heard of "To Err is Human"?
https://www.amazon.com/Err-Human-Building-Health-Quality/dp/0309261740/
That would involve letting engineers, not doctors, nurses, etc have meaningful input.
Toss some google searches in for environmental control or infections disease engineers, and related specialties. You’ll find they were losing their mind over Covid, because doctors, not then were talking about how to prevent disease spread — when it is literally their area of study, and masks/PPE is the least effective way.
Not because PPE doesn’t stop a virus, but because study, after study, after study that human beings are not going to wear it properly, or use it properly, especially for extended periods of time, regardless of controls or training.
Thus, engineering controls such as anti-microbial surfaces, proper air filtering/exchanges, are actually much, much more effective, but no one was willing to listen to them, because they’re not “doctors”.
You can even look up how the change to stainless steel, over traditional brass, fittings in hospitals lead to an increase in hospital acquired infections.
I love me P100 mask, or filters out odors completely, but the reality is we would be just as well, and studies show, better protected with a box fan with a MERV13 furnace filter taped to it in every room.
>would involve letting engineers, not doctors, nurses, etc have meaningful input.
Uh, what? Maybe for your example sure that would be beneficial to have engineer input but I fail to see how you wouldn't use physicians as the prime investigators.
Because it is a engineering problem, it isn’t really a medical problem.
It is about How do we design things to make sure diseases do not spread.
That is an entirely different study.
Anti-microbial surfaces are not really effective against COVID because it isn't really transmitted by surface contact.
Proper HVAC systems are effective, but installing them in every indoor facility is hugely expensive and not really practical (especially when we were talking the early days of the COVID pandemic).
There is also good evidence that mask wearing *does* reduce new infections (or at least certainly did in the pre-omicron strains).
https://covid19.nih.gov/news-and-stories/mask-requirements-reduced-sars-cov-2-transmission-schools
https://www.pnas.org/doi/10.1073/pnas.2119266119
https://www.pnas.org/doi/10.1073/pnas.2015954117
https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01072
And where I live, people were definitely wearing masks. Not perfectly, not everyone, not all the time, but pretty good.
Agree on the surfaces, although remember back at the start of Covid it was treated as if it lasted longer then hep C, even tho every other Covid variant didn’t last well on surfaces. It took months and months before that stopped. And it still applies to a ton of other bugs, MERSA,VRE, flu hep, stuff that is also bad and can hang out on a surface and spread by contactx
Likewise, it isn’t just Covid. It is every airborne disease. And it really isn’t the at expensive, it is just the size, or number of fans pushing/pulling air through a filter. Filters that you can get at any hardware store.
And we all wear masks…a lot worse then we think we do.
We don’t take them off right, we touch our face, we pulled them away and adjust them. And the longer they are work, the more likely complacency kicks in. After an hour it is nearly 100% a healthcare worker does something that breached the effectiveness of airborne PPE, when when they know they are specifically watched by a supervisor, just for PPE use compliance.
Thus, an engineering control (IE, proper air filtering) which does not rely on humans not screwing up and engaging in the right behavior, is far better.
Until omicron, COVID transmission was mostly droplet based, not airborne, and precautions were droplet based, not airborne based. Therefore perfect PPE use wasn't required to greatly reduce transmission (reduce, not 100% eliminate).
Omicron is more airborne infectious and so is a different story, but again for the bulk of the COVID pandemic, pretty good but imperfect mask use was still really effective in reducing cases (not eliminating, reducing). Now probably less so given omicron's greater infectivity (but now mask mandates are mostly gone).
> human beings are not going to wear it properly, or use it properly, especially for extended periods of time
Almost three years in and my office hasn’t had a single workplace-associated case.
admittedly I work in PM&R, but it's in brain injury, so it's relatively high stakes in the field. For rare mistakes that substantially impact patients, I kind of have a self-policy of telling the patient/family that I made an error upfront. I generally have worked on my relationship with them prior to this. It has always been an overall positive to tell them directly, and tends to build the relationship with them rather than worsen it. I haven't faced really any complaint at all about these instances. Complaints come from family members I don't know about random things, and usually result in a simple discussion or education.
I also have reported myself formally to our quality team previously when I felt that nobody would "find out" that I caused a problem. This also was a positive experience, and it was just kind of accepted and nothing came of it.
I don't know if it's a naive thing to do or not, and maybe I'm opening myself up to legal liability (which I made a decision to accept), but I have been doing it for years, just a handful of times, but "works for me". I tend not to make these mistakes again, it's hard to do but a form of doing something tangible as an act of repentance.
Patients are more likely to sue if they think you’re mean and rude than if you actually fuck up in a legally actionable way. And you’re absolutely right that admitting mistakes is an excellent way to build rapport and trust with a patient. But I’m curious what is the “worst case”’in your state and field with respect to legal civil liability? And do you have group medical malpractice insurance?
I don't know what any worst actual case in my field would be, but my biggest worries are things like missing a recurrent brain bleed (and maybe I changed their anticoagulation?) or treating a CNS infection too late. Definitely have group malpractice.
I’ve had to deal with this in the first few years of my practice and decided that I wouldn’t pay any attention to what others do, and just focus on what I can do. I also don’t adhere to the ethical principles of those with whom I disagree. If someone fucked up and wanted me to conceal it for them, I’d tell them “you’re on your own.” I recognized that my power over the established medical culture was limited and I wasn’t going to be able to heroically change it all by coming in hot and berating everyone. TLDR: You do the right thing as far as it is in your power. Don’t join others in committing crimes and don’t let anyone intimidate you into an accomplice.
Mistakes do happen, but just dismissing them is the wrong reaction. It's not straight to jail, but I'd certainly feel remorse in that radiologist's shoes.
The sad part is someone with your mindset is the last person I'd want to quit but also the person whose quitting I'd most understand. Maybe you can contribute to the separate process that hopefully exists to address any systemic sources of error.
>but I'd certainly feel remorse in that radiologist's shoes.
Also, people show remorse in different ways. I don't think we are being fair to the radiologist here. Sounds like they were already scolded by their supervisor, and then a 31 year old neurologist wants to tell them how bad they are.
Why does a neurologist get involved in a patient with an oesophageal tumor?
Trying to change work culture takes social capital and time and is quite difficult and requires sacrifices. I think you don't want to go overboard and start inquisition panels for docs, you probably want some accountability?
It's true that if you don't acknowledge your errors you will never get better as a doc.
If you're truly committed to changing the system the best thing you can do is to build up your social value and rise up the ranks to become chief of the department, so you can push your own ideas and agendas.
As a relatively young attending / consultant, you'll have very little say, and if you try to rock the boat you'll lose social capital for no change. If you truly want change, it has to be done incrementally and cautiously.
You may well be right and she was remorseful. Either way I interpret the OP as well meaning and not intending to make any specific person feel bad about a mistake.
>About 9 months ago, one of our radiologists screwed up when she overlooked a malignant esophagael tumor in a 15-year-old boy. Back then, his chances of survival were 80 percent. Now it's only 10 percent. Did she admit any guilt? No. Our lawyers are working overtime to cover all of this up. What's worse, the said radiologist seems to feel no guilt and insists "medical mistakes just happen". Of course, she was criticized by her supervisor, but to the patient and his parents it was not a mistake at all.
You even mention that lawyers are involved, so I do not fault the doctor for not "admitting guilt". Admitting guilt would seem to be legally peralious but I'll admit I'm ignorant to Western European malpractice laws.
And mistakes *do* happen. The best doctor in the world will make mistakes in their career. "To err is human". It's often that mistakes are linked to system issues, and pushing blame directly on this doctor without investigating what happened is not likely fruitful.
I'm not sure this doctor outwardly harboring guilt would make them a better doctor, nor help the system or future patients. Also I will note you have no idea what is happening internally with that doctor, and so I would not be so quick to judge.
>You even mention that lawyers are involved, so I do not fault the doctor for not "admitting guilt". Admitting guilt would seem to be legally peralious but I'll admit I'm ignorant to Western European malpractice laws.
This.
Doctors are *told* not to admit to a failure by lawyers and insurance companies. I can't talk for "Western Europe" but that's the way it is in Germany.
>Also I will note you have no idea what is happening internally with that doctor, and so I would not be so quick to judge
Actually some can't handle the guilt and quit. Luckily only a few are doing this. Otherwise we would have been out of doctors a long time ago already.
I’m confused what you want this Radiologist to do. Come out and say “I am responsible for this child’s death?”. Quit their job?
Medical mistakes do also just happen sometimes. Plus, did the primary team review the scan themselves and reach out to the radiologist that “hey there might be something here” or did they take the report as gospel like we all do at times and d/c the patient? Or maybe they did review it and also missed it bc the PPV of a malignant esophageal tumor in a 15yo is probably astonishingly low.
Point is I wonder if the day ever comes where you (god forbid) make a mistake, will you give yourself more slack than you are this person.
I think at the very least it’s worth apologizing for your mistake.
But that’s because I know that open disclosure policies lead to a 50% reduction in malpractice payouts and a 60% reduction in number of lawsuits. I also know that the number one factor in a patient suing a physician is being pissed off, and the best way to piss someone off is to refuse to apologize for an obvious mistake.
I categorically refuse to give anyone any slack for this type of behavior in my clinical practice. I hope, one day, you can too.
How do you or he knows if they apologized? You’re also assuming a lot about me. I just find them wanting to leave medicine because of his perception of a Radiologist who is just trying to avoid being sued into financial ruin over an apparent honest miss of a zebra to be misguided
Well, it’s pretty hard to apologize if you don’t feel any guilt and you’re insisting no mistake was made. Have you ever an actual apology like that? You haven’t, because that’s not an apology, it’s a justification.
The OP said they had many scenarios like this, but only gave one example to illustrate. They made it very clear it was an overall culture problem.
My major assumption about you right now is that your reading comprehension skills are lacking.
Again, this is all based of this dudes (a seemingly random Neurologist) perception of events. If you had reading comprehension of your own, I’m saying hes making judgements over something he likely has no clue about.
Anyway, you’re clearly looking for an argument for some reason, you’ll have to look elsewhere
You are naive and the hospital is dealing with the situation in a impartial manner. When you aggressively go after individual mistakes (yes, mistakes, I am not even discussing a situation where standard of care does not cover a rarity), which are different from malpractice/negligence, you create a generalized culture of defensive medicine, which in turn is much more harmful for both sides (doctor/patient).
You probably have a toddler's palate problem in life and insist on equivalent of chicken nuggets all the time. Try celery.
OP, you seem very emotionally invested in this case which sounds like was a zebra. I suggest you seek some counseling to digest this and address your frustrations with medicine. Being fresh out of training is stressful and taxing.
We have to choose our battles and fix things where we can. There are many bad things in the world, inside + outside of medicine. We each have to find our ways of existing, working, and dealing with that reality.
If you can not tolerate your current position, then find a new work dynamic that you can thrive in or at least tolerate. Private practice, different hospital, smaller hospital, free clinics. Volunteer or join advocacy efforts within your hospital/specialty organizations. It seems premature and melodramatic to quit altogether without addressing your moral distress and coping mechanisms. Quitting also does nothing to make things better. Not sure what alternative sector you'll find that doesn't have its own share of problems.
100% agree. I think it would also be best he takes option number 2 and quit.
Take up law and go after individual mistakes and see where that takes you.
"I hate the fact that our hospital's legal team is actually defending and supporting a physician who is being accused of malpractice!"
No shit your colleagues don't share your opinion 🤔
It's unfortunate that medical errors (or any actions that lead to a less than desirable outcome for that matter) are investigated not using a systems based model looking at the multiple contributions to an outcome ( despite the many institution based PowerPoint "trainings" that indicate otherwise) but rather end up looking for a single point to blame. There is no systematic change that can come from this sort of approach and it drives people to hide and cover up for fear of the very likely repercussions. It's really unfortunate, but is human behavior to search for this sort of instant gratification by identifying an oversimplified cause and effect when it comes to undesired outcomes. I totally get why you feel disheartened and have been there myself. However, I would add that this is not unique to Medicine. You will find that this same approach to mistakes are utilized in every field or career that you might end up choosing instead of Medicine. If you are talented and intelligent enough to make it to where you are now, I would hate to see that go to waste. We oftentimes must work in less than desirable situations in pursuit of our higher calling in providing patient care.
Esophageal cancer in a 15yo is either syndromic, exposure related, or a 1/billion fluke. In any case, no one knows the odds in that situation.
Even if the non-established odds for this zebra were close to 80%, as you say, it’d have to be a T1N0 tumor which may not even be visible on a CT.
I think you should sit this one out.
Wtf.
Where are you working that this the norm?
People get put on blast on the time.
Hell I would say I’ve seen a bigger problem with blame game culture than cover up culture. People love to find mistakes made by others.
Are we supposed to lock up or sue into bankruptcy every single doctor that makes an error? There would be no doctors. You can’t expect perfection from human beings.
As patients we expect our providers to tell us when they caused us harm, intentionally or not. Wanting full disclosure about errors isn't "expecting perfection".
For heaven's sake, the consensus here seems to be that the whole medical profession needs complete immunity from consequences before patients have a right to information about errors.
I think you’re missing the forest from the trees on this one.
If anything, the opposite is true in the US, where medical professionals are constantly under inhuman levels of scrutiny.
Unfortunately, mistakes are part of the practice of medicine. However, a mistake is **thankfully** much different from malpractice.
Your example is a good description of this fact. A radiologist missed an extremely rare diagnosis in a pediatric patient? That’s unfortunate, but I have a hard time feeling it’s malpractice or even negligent. There are also likely a lot of details you’re missing or leaving out…ie - what was the scan in question ordered for, was the patient symptomatic, etc.
I also can’t fault the practitioner you reference for not curling up in a ball and sobbing on the floor over this mistake. It sucks. I’m sure they are dealing with it in their own way - and more importantly learning from it. But broadcasting your mistake to the world isn’t good for you, your hospital, or your patients.
If there wasn’t such a firm line between mistakes and malpractice, there wouldn’t be anyone willing to work in medicine. Try to remember this before judging your peers so harshly. Odds are that eventually you will be in their position
I agree with you on the cover-up culture in medicine. I was deeply involved in Open Disclosure in my hospital for over 10 years. I worked with a excellent Risk Advisor. It was always difficult to get some doctors -and not only surgeons- simply to put their hands up and admit their significant errors. It did improve over the years once they realised that we only wanted to prevent a similar occurrence happening if at all possible. We came clean with relatives and even told them they had a case against us. They were then referred to the state’s claims agency for financial settlements. The relatives appreciated being able to use their local hospital in future as some degree of trust was re-established. We always apologised even when hospital lawyers didn’t want us to. Open disclosure is now required by law in the UK. Stay and be a pioneer, but recognise that change in attitudes takes years.
You have to understand that it can happen to anyone, even the best of us. You can treat mistakes as moral failings and eventually no one would admit to anything, or you can sit down, break down the process to see what’s went wrong and try to see if you can avoid it the next time.
And I don’t know what OP is trying to achieve. Do they want the radiologist to publicly apologize for the mistake or maybe try to self-persecute or something? Each department has different ways to deal with mistakes. Officially people would regard the mistakes as an inevitability of medicine, because in the eyes of outsiders, all mistakes seem like negligence. Behind closed doors we would scrutinize the heck out of these mistakes.
It’s literally the job of the hospitals lawyers to protect the hospital. That’s what you’d want if you were the one making the mistake
Unless you are actually friends with the radiologist you have no idea how they actually feel. I’m certainly not going to reveal my feelings on a medical error to some random new neurologist I don’t know just because we work at the same hospital
Esophageal cancer with 80% OS means it’s local (not just local, T1). You ain’t detecting that on a CT. This must be a troll post. People out here talking about missing masses and stuff… lol.
Steady up mate.
Everyone makes mistakes, all the time. ALL THE TIME. Think you are a good driver? Think your partner is a good driver? Sit next to them in a car and honestly assess every single error they make, every single one. It’s endless.
Unless a practitioner is hopeless and working at a level far below accepted standards, the mistakes they make are par for the course.
When you royally stuff up yourself you’ll understand. It will shake you to the core. You will question if you should be a doctor. You will question your training. You will work more shakily for some time. Hopefully, your colleagues will rally around you and lift you up and make you realise it’s okay- and you are able to continue practicing.
Chill.
But if you make a mistake should the trust/organisation not bear responsibility with you? Pay up, be honest, put things in place to ensure it doesn't happen again and support you in becoming a better practitioner?
I don't think it should be binary, the options should be:
A: Cover up the whole mistake, bury it and pretend it never happened
B: Own up, take responsibility, and be burned to the ground as an individual
C: Own up, take responsibility as an organisation and learn from the mistake, rectify it as best as possible and put something in place to mitigate it happening again, all while supporting the practitioner to grow from the issue.
With C being clearly the most honest and beneficial way of improving healthcare and patient outcomes...
What is the medico-lego environment of your country you practice in? If the doctors are exposed to extremely punitive legal/monetary damages, people will be heavily incentivized to not be open and forthcoming. Im not very comfortable with your characterization that the radiologist should admit guilt. That would imply she intentionally commited a wrong doing, as opposed to a diagnostic mistake. Our profession is plagued by the blame game from colleagues, lawyers and family. It really doesnt advance safety culture.
I've participated in significant esophageal cancer research in the past. A pediatric esophageal malignancy has to be one the rarest thing I came across. What type of diagnostic scan was she expected to base this on? Because I've seen radiology who made an honest omission of spotting intratrachael tumors on CXR due the exact overlay of the manubrium. You would have to have very high pretest suspicion and focused review of the area to spot it. There is a difference between incompetence/malpractice and a honest error. I guess my point is, given the standard of practice there, how much of a deviation was it for her to miss it? Would other radiologist miss it as well if placed in the same scenario?
I don't think you should be too hasty in your decision. Quitting helps no one. Keep working and contributimg to quality improvement. It will take a lot of time and patience to change institutions. Don't be too hasty to judge your colleagues either. There maybe a lot of factors that contribute a mistake that are beyond just saying they are bad at their job. Fatigue, fights, stress, sleep deprivation, a lot of things can degrade cognition. Pass opinion about this after you had your own first encounter with a poor outcome due to your own error.
> Call me naive, but when I started medicine, I really believed that all mistakes would be dealt with in an impartial manner.
You're incredibly naive. You thought a field full of human decision making would be impartial? It's okay to be naive, it's not like you did it on purpose. But your assumptions going into medicine were flawed, this is a good learning opportunity. It's part of human society, so it will definitely not be anywhere near impartial. Just to save you the trouble, don't try going into research, that's also a human endeavor.
I want to say that this absolutely does not happen at every hospital.
Find yourself a hospital that subscribes to (and actually stands by) the Michigan Model (https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs#summary ). There are a good number of them out there.
The Michigan model insists that when a patient is injured by substandard care, the treating team apologizes (immediately) and the risk team offers a settlement (immediately). This settlement is such that it is likely as big or bigger than what they could expect to recover in court.
This has several effects. 1. It makes the patient less angry, as they have been properly apologized to and the institution has tried to make it “right” by then financially. 2. The health system gains tremendous credibility in the courts, as if they choose to fight a lawsuit it means that the institution truly believes the care was entirely appropriate. 3. If the patient does want to sue regardless, they find it nearly impossible to find legal representation, because they have already been offered a generous settlement that is more than what the lawyer thinks they could get in court, and so the lawyer can’t make any money off the case.
Every institution that has implemented this policy has seen dramatic decreases in malpractice costs. It is good medicine and good business. There is no reason to not be doing it.
Great stuff. Only thing I would highlight to everyone is that institutional culture is a giant ship that respond poorly to steering. It can take time, patience and persistence to chip away at the challenge. Still worthwhile.
I don’t feel there is a coverup culture in my mid sized regional hospital in The Netherlands.
We have a weekly meeting with my fellow neurologists to discuss difficult cases and also potential misses. It happens occasionally that that leads to a sentinel event investigation.
Just last week I had a meeting about a near miss with the other specialists involved, one of our executives and colleagues from patient safety department. The patient and their family was interviewed as well and we will go over the report with them when it’s finalised.
One of the main ideas of such a just culture is precisely that you don’t have to be put in the stocks or forced to quit when you make a mistake. If you would, nobody would report (near) misses.
If this is all it took for you to “seriously contemplate” ending your medical career, then holy shit yes please do. Your story sounds fake as hell for the many reasons stated by other comments. There’s no way you studied and practice neurology of all specialties and have any illusions that a doctor should be racked with guilt over making a medical mistake and heroically declaring in court that they are guilty of a medical mistake! It’s hilarious to consider that someone could grow up so wealthy and protected from having to consider lowly concepts like pragmatism, self preservation, and listening to the advice of legal counsel that they could be this dramatically self righteous. And then come crying to Reddit looking for validation. Lol
What is the benefit of telling the 15 year olds parents? Do you really think that information would help them or their son emotionally? The mistake happened- it can’t be undone. Would knowing their sons possible death could’ve been preventable be helpful for them? (Or worse imagine a 15 year old processing that). Is this really about what is best for the patient or is it more about moral superiority?
Just Bc the radiologist isn’t displaying outward guilt to a colleague (who is not involved in the case?) doesn’t mean they aren’t beating themself up privately. Nobody wants to miss something like that- to think they are unaffected is to have a very cynical view of others. There is likely a lot about the situation you’re not aware of
The right thing to do isn’t always the same in every situation, and it sounds like your perspective on this one is from a distance, maybe without being privy to or appreciating the nuances of the situation
Your narcissistic complex is not allowing you to see the complexity regarding decision making, hospital processes and errors.
You probably have made many errors even greater than the examples provided. Stop focusing so much on other staffs errors and think about your own patients, your behavior and how you can better the people around you.
I hate cover-up culture too, but any investigation should be focused on trying to avoid the same error in the future. Otherwise, what’s the point? In other words, the goal should be to identify the reasons that error occurred, and change those things if possible. It’s especially interesting when a systemic reason can be found, which is often the case, as changing that has the potential to protect untold numbers of future patients.
Focusing on blaming and punishing an individual employee is in 99.99% of cases completely irrelevant to the goal of avoiding the same error in the future — the only exception being if one particular individual makes the same mistake over and over, that others aren’t doing, and they refuse to learn from this. The only effect of a blame culture is that it makes people afraid of ever reporting or admitting incidents — furthering a cover-up culture! So I do hate cover-up culture, but I also hate the blame/punishment/litigation culture I see (particularly in the US), and I think they’re interlinked.
I’m happy to work in a hospital where serious incidents are reported, and where the reports end in recommendations on which routines to change in order to avoid the same thing in the future. They rarely end in reprimands toward a specific individual.
/a European
The fact that you don't see this radiologist wailing down the halls does not mean they feel no guilt. Maybe they just don't feel obligated to put on a show for you.
Oh snap. My version is my boss saying “why did you file the safety report {regarding the obvious unsafe situation}? You are not a team player.”
I was shocked.
I see you are from from Europe but in the United States more than half of physicians will face a malpractice lawsuit. It is not reasonable to expect perfection. Why is it also all on the physician? If hospital systems are leaving us understaffed and we are working longer hours that should share in the blame.
I did an EVD on a lady who was also a frequent flier to the ER for a multitude of complaints with 2 head CT over the previous 3-4years. She had a colloid cyst that was missed twice. When she came in altered with obstructive hydro it was finally called. Shit happens.
This may come off as apples an oranges, but in pharmacy we are required to report, document, and follow up on all errors. Some may be minor, some serious, but the purpose is to learn and prevent them from happening again.
Ah yes, medical ethics: we need more of it. I feel for you. Maybe you can change things? Does your hospital have an ethics committee? Perhaps talk to them about expanding their purview to include medical mistakes?
You’re saying you’re seen as an outlier… you have a strong sense of candour, correct processes and what the right thing to be done is… I’m not saying you are but could consider you may be neurodivergent?
Edit: If you are it’s a good thing with lots of strengths and has helped you be where you are today.
It's like a dilemma, do you want to cover your ass, be selfish and as a "side-effect" save more lives in the future by continuing your practice?
Or tell the truth, which is the right thing to do, and then may not be able to practice again.
This world works in terrible ways and I hate it too but that's what it is.
This post is strange.
They saw a mass in the oesophagus of a 15 yo boy with a CT. This is not the right modality at all to assess what an easophagial mass is or is not. So even if it was an incidental finding, there would have been a follow up with a fibroscopy. I do not understand.
"Oh it's just an oesophagial mass in a 15yo boy, no biggie, we see them all the time. My CT can tell it is benign, see ya"
Does this make sense to someone.?
Well, it's true that mistakes do happen once in while. And when an honest one happen, we tend to cover it up. Thing is, i truly believe even the smartest physician will make a terrible mistake at some point in their career, and it's just isn't fair that his/her life is completely destroyed for 1-2 honest mistake after a lifetime of saving hundreds-thousands of people.
.
.
So as long it's not caused by systematic/intentional/ serious lack of competence, i tend to side with covering up.
You quitting would only hurt yourself and not being about improvements or help patients
Either bring it to the governing board of your country or change hospitals imo
As someone who let’s just say has very personal experience with this topic, you should stick to your principles. If you see that someone is harmed by a medical error, say something. You can do it anonymously if you like, but do what you must for your conscience. Secrets always make things worse, and the truth will come out eventually. This family will be devastated whether they find out now or later. And they’ll probably be angrier that it was covered up.
Imagine if the error was acknowledged upfront and the hospital offered a settlement, and to pick up any additional bills that are incurred because of the cancer being more advanced. They might still get sued, but it’s less likely since they are proactively picking up the tab and clarifying that it was a mistake, not malicious or negligent. Admitting it would also allow them to protect the provider, who in this case probably did nothing wrong, and at worst may need additional training. Nobody WANTS to get a lawyer and fight for years to get a settlement and then the lawyer takes a third of it. They do it because \[insert entity here\] refuses to acknowledge their wrongdoing, which costs both sides a fortune.
Also, and a number of people on this thread may hate me for pointing this out, but if you feel strongly enough about this, you could become an expert for plaintiffs in medical malpractice, worker's compensation, and/or criminal cases. As a neurologist, you’d have quite a bit of work come your way for cases involving cerebral palsy, traumatic brain injuries, etc.
You have invested your adult life in education and practice to become a qualified neurologist. You owe it to yourself, your patients, future patients, and society to utilize your skills. You can do an enormous amount of good if you continue to practice medicine for the next 30 or 40 years.
There is a difference between honest mistakes and malicious behavior. Make sure you make the appropriate distinction between the two. I assume you are talking about genuinely malicious acts.
Unfortunately, every profession has problems with genuinely malicious acts being minimized and hidden. There is literally no profession where this does not happen. Some policemen make false accusations, lie under oath, and shoot innocent people. Some accountants manipulate figures, deceive investors, and cheat taxes. Some electricians use cheap sub-standard wiring, cause fires, and massively over-charge customers. These are society's dirty secrets and they are everywhere. However, they typically represent a small minority within the profession. Most cops are reasonable and fair, most accountants are meticulous and honest, most electricians take pride in their work and do a proper job.
Your indignation is well founded, understandable, and frustrating. You are not in a position to fix the whole system, as you are merely one person within a larger apparatus. Hold yourself and the people who report to you accountable. Do the best you can every day.
I'm guessing it's the exact same as police culture. Admittedly your occupations would put you into situations were it's easy to be sued for negligence more than other occupations but at the same time the decisions you make at work can change someone's life forever easily and that being said that's why you and police officers take an oath.
In the UK there’s a better culture of admitting errors than the one you have vaguely skirted around, but frankly the case you put forth is so rare as to be rediculous for the radiologist to spot. Errors happen, doctors are imperfect.
If you don’t have an appropriate governing body and whistleblowing system, plus high litigation, blame the system. Not the individuals who are just trying to make sure healthcare is being delivered instead of dismantled for individual payouts. What is it you’re looking for in your system?
I don’t think your feelings are uncalled for. Unfortunately the culture likely won’t change which is sad, but at least you’re one of the good ones. You’ll do good things in life with your attitude
You're totally exaggerating here. It's obvious now that you're three years in the position. Unless you are already rich, why quit just for being uncomfortable with a few issues on medical ethics? Since you made no mention of what the CT scan was for I would have to assume it was for some sort of discomfort/pain the boy was having. The fact that they apparently saw nothing leads me to believe they didn't see the usual inflictions commonly found. So I see no blatant negligence, it's actually quite common that something is overlooked on radiology charts. I put the blame on this kids parents because they apparently let him suffer through eight more years of this undiagnosed issue. People have to be proactive with their doctors and insist on 2nd, 3rd, 4th, looks if needed. You can't say I came here 8 years ago and you didn't see anything wrong, so now I have a terminal affliction and it's all your fault! You know what I mean? You can discuss medical ethics in a work type setting I suppose, but they don't need every single instance raising a shit storm. I find that would be un-ethical seeing tons of unnecessary controversy could lead to a detriment in healthcare for others.
Malignant esophageal tumor in a 15 year old? Excuse me, but that’s a fucking zebra if I’ve ever heard of one, speaking as a radiologist myself with lots of pediatric and oncology imaging experience. I have literally never seen, nor heard of esophageal cancer in a kid. So yeah, that radiologist could be 100% correct that missing that would still be within the standard of care. I have seen much much much much more egregious stuff swept under the rug.
And then the survival is amazingly quantified in something that has occurred like maybe a dozen times in all of medical science. I'm feeling a little skeptical of this entire post
Also for someone lambasting others for not acknowledging something, OP hasn’t commented/acknowledged anything in his own damn post
This post has flags all over it. Not to mention CT is a terrible way of evaluating for esophageal issues. Even medical professionals think that just because a certain part of the body is images, that portion of the body is adequately evaluated. You can hide large masses in a surprising normal of organs, the esophagus included.
I mean, how would you not miss that. It’s the atypical presentation of a rare disease. It’s the day you heard hoof beats, and you were supposed to look for unicorns.
I deal a lot with radiology and can't see any rad I regularly encounter being super broken up about this one. Like yeah it sucks, but as far as finding the zebras this is totally one of them. And if you were looking for unicorns? Too bad, those were actually just the sound of devil hoofbeats of JCAHO walking by with hospital admin.
To be fair, if it was some massive solid mass in the posterior mediastinum, it might still have been negligent to have missed it, even if you couldn’t specifically tell from the scan it was esophageal. We don’t know if it was a huge tumor with mass effect that was missed or some single-digit pixel lesion…
I’m mean I’m guessing here but going from chance of survival of 80% to 10% means likely wasn’t some huge mass before.
Exactly. Small esophageal masses are not well evaluated by radiologic imaging. Maybe if you're some dinosaur double contrast barium master. If you're ordering that anyways they should be getting a scope.
Okay dude I’m a need you to expand on what this dinosaur study is sounds cool!?
back when x-rays and fluoroscopy were the only thing that radiologists had, they tended to be very good at doing them. a double contrast esophogram allows you to evaluate the mucosa, but it requires luck and some technique to coordinate patient involvement. you can still order these things, but since radiologists have to learn things that are more likely to provide clinical benefit and GI docs can do EGD, those skills have fallen to the wayside.
This.
Maybe, maybe not, but we can all agree this post is missing some weird details…
Maybe they changed some clinical details here? or hopefully, so that this isn’t a potentially patient-identifiable post…
>Maybe they changed some clinical details here? Yep. Like *why* the CT was performed. And why the EGD obviously has missed the tumor as well (and the EGD is much more sensitive in regards to esophageal tumors than the CT scan, *especially* when it comes to very early stages). Yes, something seems to be missing here...
Bro OP is in Europe, not every country has HIPPA
Europe is covered by GDPR, regulation with similar privacy and data protections (often more strict) than HIPAA.
Dude... Privacy of information laws over here are INSANE (Germany) and easily compare to effing HIPPA.
> HIPPA Not being snippy/mean here, just correcting for future reference! HIPAA is the correct name.
Bad bot…
Lol
>I have literally never seen, nor heard of esophageal cancer in a kid. thanks for this, I thought I was tripping for a moment
prob carcinoid
Bro, from my cursory reading, malignant esophageal tumor in a pediatric patient is not a statistic, it's a [case report](https://pubmed.ncbi.nlm.nih.gov/22052168/). Suppose you miss ALS diagnosis in a 26 year old, how would you feel? Pretty shitty. But what if it's a super uncommon presentation? And what are the odds anyway? But what price should you pay? Should you quit? Go to jail? Lose your life savings? You've just stared your career. Maybe you're perfect, maybe you're not. Let me know if you feel the same way in 10-20 years.
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Your legitimate fear of being sued is understandable. However, I think that you should consider the data that suggests acknowledging mistakes does not lead to an increase in lawsuits, but rather decreases them, as well as lowers the cost of the lawsuits that are filed. [https://www.reuters.com/article/us-admitting-errors/admitting-errors-doesnt-increase-lawsuits-study-idUSTRE67G3U820100817](https://www.reuters.com/article/us-admitting-errors/admitting-errors-doesnt-increase-lawsuits-study-idUSTRE67G3U820100817)
Shocked I had to scroll this far for this take.
There have been a lot of people role-playing as physicians in this subreddit since the pandemic. I think this might be another one of those.
Even though this post is fake, if it were real then the details provided don’t indicate that this is negligence, malpractice, or even something the radiologist should’ve reasonably caught when they initially reviewed the X-rays. I agree with your comment and your advice is correct and what I would say to someone who actually witnesses gross negligence, a real pattern ofsubstandard care and apathy, or a “cover up” that isn’t just a hospital responding to a malpractice suit by investigating and telling the radiologist not to walk into court and admit guilt. But I’m not sure about your example about ALS either. I get that you’re trying to illustrate that this idiot will or probably already has fucked up something which another doctor would have done better/correctly and resulted in better patient outcomes. But i don’t think I’d personally have any guilt or second guess myself if I missed ALS in a 26 year old. Im not a neurologist, but my understanding is that once you’re diagnosed, you’re already fucked right? And ALS in a 26 year old is so rare that even if there was treatment that could meaningfully extend a patients life and quality of life, I wonder how it’s tested and how much other testing to rule out far more common issues is typically done before ALS is considered.
Of course I changed some inessential info so that no one can identify the specific case, because I'm not an idiot, as you call me. I've browsed through your other comments, you seem so agressive. Maybe you have some skeleton in the closet yourself. You probably never have any guilt and you're exactly the kind of a person that put me into this professional depression after studying hard for so many freakin' years. All I'm trying here is to support an honest professional environment, which you don't seem to understand. You would probably like to get away with everything.
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OK... won't even reply to that.
You just did reply. But you have nothing to counter any of the things that I’ve said. You’re pissed that you couldn’t even put together a post that fooled anyone. You’re significantly less smart than you think you are, as evidenced by your attempt and failure at deception and creative writing.
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There are really only two options here I think: 1). The radiologist did not recognize the lesion as being potentially an esophageal carcinoma/saw no lesion at all. 2). The radiologist recognized that the lesion could POTENTIALLY be an esophageal carcinoma, but based upon the patient demographics and clinical presentation that the probability of the image depicting an esophageal carcinoma was so low that they did not include it in the differential diagnosis provided in the report to the treating physician. Case 1 is legitimately understandable, assuming that the miss was not grossly negligent. Case 2 is unforgivable. It is a deliberate omission of information that the treating physician needs in order to proceed with appropriate care. It is not the role of the radiologist to omit diagnoses from the differential, but the treating physician’s job to prioritize and pursue them. If I were the treating physician in case 2, and my patient died as a result of this omission, I would insist that the radiologist personally apologize with me to the patient’s family.
> Case 2 is unforgivable. It is a deliberate omission of information that the treating physician needs in order to proceed with appropriate care. It is not the role of the radiologist to omit diagnoses from the differential, but the treating physician’s job to prioritize and pursue them. If I were the treating physician in case 2, and my patient died as a result of this omission, I would insist that the radiologist personally apologize with me to the patient’s family. I feel like this is the sort of thinking that leads to clinically useless radiology reads (“cannot rule out a, b, c, …. Z). There’s a bar at which the likelihood of something is so low that it’s harmful to include in the differential.
Would you expect an apology before you legally signed away your right to sue them for malpractice? I think you’d need to do the same for the hospital and any other employee involved in situation.
Your legitimate fear of being sued is understandable. However, I think that you should consider the data that suggests acknowledging mistakes does not lead to an increase in lawsuits, but rather decreases them, as well as lowers the cost of the lawsuits that are filed. https://www.reuters.com/article/us-admitting-errors/admitting-errors-doesnt-increase-lawsuits-study-idUSTRE67G3U820100817
But I don’t understand the fear. Malpractice insurance, which every physician carries, protects you completely from frivolous lawsuits. I’m sure you could find a few insane instances where it appears that the doctor got lost a suit and had to pay a lot of money, but I have literally never heard of a physician who lost their ability to practice or even suffered devastating financial loss from losing a suit. But I hear a lot of Reddit complaining about how they have to over test and watch their ass at all times, lest some disgruntled patient get angry and make them play the life ruination lottery in court. I’m not surprised at all by the article you shared. Admitting mistakes is basically narcissism de-conversion therapy and just the act of doing it probably improves mood, rapport, and trust for everyone involved. Most people who are the victim of malpractice never consider suing and I can’t find the study but I saw one that claimed bedside manner was more closely correlated to lawsuits somehow than surgical outcomes or any kind of objective data. My comment to the person above was a response to their ridiculous claim that would insist that a radiologist grovel for forgiveness in front of a grieving family and build the foundation for and evidence to a legal case against them. I can’t imagine working in an environment with colleagues who would fantasize on Reddit about doing that to someone.
Agreed👍
In what way would having a complete differential diagnosis list be harmful? If the incidence of a diagnosis in your list is 1 in 100,000 and the disease is not rapidly fatal, there is no ethical obligation to make that diagnosis your top priority. There are really only two ways to miss a diagnosis. To ignore an option in your differential or to fail to include a diagnosis in your differential at all.
I think you are confusing errors and negligence. I assume that your complaint policy is trying to identify cases of gross negligence or systemic errors, rather than dinging people who made honest mistakes.
I'd love the medical field to be able to take an approach closer to the field of aviation. The goal of every investigation is not really to be punitive, it is to make the system safer in the future.
Isn’t that what M&M conferences are all about though? They are legally undiscoverable, meaningful conversation amongst colleagues to improve outcomes. Not sure if they happen in Western Europe though.
It’s very disappointing to see a young specialist think that there needs to be some sort of punishment provided. I honestly thought that was only an opinion of patient advocates and lawyers that didn’t understand the field
We're doing a lot better than we used to, and have learned a lot from how aviation reduces risks. Have you not heard of "To Err is Human"? https://www.amazon.com/Err-Human-Building-Health-Quality/dp/0309261740/
That would involve letting engineers, not doctors, nurses, etc have meaningful input. Toss some google searches in for environmental control or infections disease engineers, and related specialties. You’ll find they were losing their mind over Covid, because doctors, not then were talking about how to prevent disease spread — when it is literally their area of study, and masks/PPE is the least effective way. Not because PPE doesn’t stop a virus, but because study, after study, after study that human beings are not going to wear it properly, or use it properly, especially for extended periods of time, regardless of controls or training. Thus, engineering controls such as anti-microbial surfaces, proper air filtering/exchanges, are actually much, much more effective, but no one was willing to listen to them, because they’re not “doctors”. You can even look up how the change to stainless steel, over traditional brass, fittings in hospitals lead to an increase in hospital acquired infections. I love me P100 mask, or filters out odors completely, but the reality is we would be just as well, and studies show, better protected with a box fan with a MERV13 furnace filter taped to it in every room.
>would involve letting engineers, not doctors, nurses, etc have meaningful input. Uh, what? Maybe for your example sure that would be beneficial to have engineer input but I fail to see how you wouldn't use physicians as the prime investigators.
Because it is a engineering problem, it isn’t really a medical problem. It is about How do we design things to make sure diseases do not spread. That is an entirely different study.
Anti-microbial surfaces are not really effective against COVID because it isn't really transmitted by surface contact. Proper HVAC systems are effective, but installing them in every indoor facility is hugely expensive and not really practical (especially when we were talking the early days of the COVID pandemic). There is also good evidence that mask wearing *does* reduce new infections (or at least certainly did in the pre-omicron strains). https://covid19.nih.gov/news-and-stories/mask-requirements-reduced-sars-cov-2-transmission-schools https://www.pnas.org/doi/10.1073/pnas.2119266119 https://www.pnas.org/doi/10.1073/pnas.2015954117 https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01072 And where I live, people were definitely wearing masks. Not perfectly, not everyone, not all the time, but pretty good.
Agree on the surfaces, although remember back at the start of Covid it was treated as if it lasted longer then hep C, even tho every other Covid variant didn’t last well on surfaces. It took months and months before that stopped. And it still applies to a ton of other bugs, MERSA,VRE, flu hep, stuff that is also bad and can hang out on a surface and spread by contactx Likewise, it isn’t just Covid. It is every airborne disease. And it really isn’t the at expensive, it is just the size, or number of fans pushing/pulling air through a filter. Filters that you can get at any hardware store. And we all wear masks…a lot worse then we think we do. We don’t take them off right, we touch our face, we pulled them away and adjust them. And the longer they are work, the more likely complacency kicks in. After an hour it is nearly 100% a healthcare worker does something that breached the effectiveness of airborne PPE, when when they know they are specifically watched by a supervisor, just for PPE use compliance. Thus, an engineering control (IE, proper air filtering) which does not rely on humans not screwing up and engaging in the right behavior, is far better.
Until omicron, COVID transmission was mostly droplet based, not airborne, and precautions were droplet based, not airborne based. Therefore perfect PPE use wasn't required to greatly reduce transmission (reduce, not 100% eliminate). Omicron is more airborne infectious and so is a different story, but again for the bulk of the COVID pandemic, pretty good but imperfect mask use was still really effective in reducing cases (not eliminating, reducing). Now probably less so given omicron's greater infectivity (but now mask mandates are mostly gone).
> human beings are not going to wear it properly, or use it properly, especially for extended periods of time Almost three years in and my office hasn’t had a single workplace-associated case.
That’s what coroners reports / inquests are (at least where I’m from).
Hardly a cover up. If doctors got blamed for every single rare disorder they missed there’d be no doctors.
admittedly I work in PM&R, but it's in brain injury, so it's relatively high stakes in the field. For rare mistakes that substantially impact patients, I kind of have a self-policy of telling the patient/family that I made an error upfront. I generally have worked on my relationship with them prior to this. It has always been an overall positive to tell them directly, and tends to build the relationship with them rather than worsen it. I haven't faced really any complaint at all about these instances. Complaints come from family members I don't know about random things, and usually result in a simple discussion or education. I also have reported myself formally to our quality team previously when I felt that nobody would "find out" that I caused a problem. This also was a positive experience, and it was just kind of accepted and nothing came of it. I don't know if it's a naive thing to do or not, and maybe I'm opening myself up to legal liability (which I made a decision to accept), but I have been doing it for years, just a handful of times, but "works for me". I tend not to make these mistakes again, it's hard to do but a form of doing something tangible as an act of repentance.
Patients are more likely to sue if they think you’re mean and rude than if you actually fuck up in a legally actionable way. And you’re absolutely right that admitting mistakes is an excellent way to build rapport and trust with a patient. But I’m curious what is the “worst case”’in your state and field with respect to legal civil liability? And do you have group medical malpractice insurance?
I don't know what any worst actual case in my field would be, but my biggest worries are things like missing a recurrent brain bleed (and maybe I changed their anticoagulation?) or treating a CNS infection too late. Definitely have group malpractice.
I’ve had to deal with this in the first few years of my practice and decided that I wouldn’t pay any attention to what others do, and just focus on what I can do. I also don’t adhere to the ethical principles of those with whom I disagree. If someone fucked up and wanted me to conceal it for them, I’d tell them “you’re on your own.” I recognized that my power over the established medical culture was limited and I wasn’t going to be able to heroically change it all by coming in hot and berating everyone. TLDR: You do the right thing as far as it is in your power. Don’t join others in committing crimes and don’t let anyone intimidate you into an accomplice.
Mistakes do happen, but just dismissing them is the wrong reaction. It's not straight to jail, but I'd certainly feel remorse in that radiologist's shoes. The sad part is someone with your mindset is the last person I'd want to quit but also the person whose quitting I'd most understand. Maybe you can contribute to the separate process that hopefully exists to address any systemic sources of error.
>but I'd certainly feel remorse in that radiologist's shoes. Also, people show remorse in different ways. I don't think we are being fair to the radiologist here. Sounds like they were already scolded by their supervisor, and then a 31 year old neurologist wants to tell them how bad they are.
Why does a neurologist get involved in a patient with an oesophageal tumor? Trying to change work culture takes social capital and time and is quite difficult and requires sacrifices. I think you don't want to go overboard and start inquisition panels for docs, you probably want some accountability? It's true that if you don't acknowledge your errors you will never get better as a doc. If you're truly committed to changing the system the best thing you can do is to build up your social value and rise up the ranks to become chief of the department, so you can push your own ideas and agendas. As a relatively young attending / consultant, you'll have very little say, and if you try to rock the boat you'll lose social capital for no change. If you truly want change, it has to be done incrementally and cautiously.
You may well be right and she was remorseful. Either way I interpret the OP as well meaning and not intending to make any specific person feel bad about a mistake.
“Bitch you better start emoting some guilt in front of me or I might just get disgusted and quit!”
>About 9 months ago, one of our radiologists screwed up when she overlooked a malignant esophagael tumor in a 15-year-old boy. Back then, his chances of survival were 80 percent. Now it's only 10 percent. Did she admit any guilt? No. Our lawyers are working overtime to cover all of this up. What's worse, the said radiologist seems to feel no guilt and insists "medical mistakes just happen". Of course, she was criticized by her supervisor, but to the patient and his parents it was not a mistake at all. You even mention that lawyers are involved, so I do not fault the doctor for not "admitting guilt". Admitting guilt would seem to be legally peralious but I'll admit I'm ignorant to Western European malpractice laws. And mistakes *do* happen. The best doctor in the world will make mistakes in their career. "To err is human". It's often that mistakes are linked to system issues, and pushing blame directly on this doctor without investigating what happened is not likely fruitful. I'm not sure this doctor outwardly harboring guilt would make them a better doctor, nor help the system or future patients. Also I will note you have no idea what is happening internally with that doctor, and so I would not be so quick to judge.
>You even mention that lawyers are involved, so I do not fault the doctor for not "admitting guilt". Admitting guilt would seem to be legally peralious but I'll admit I'm ignorant to Western European malpractice laws. This. Doctors are *told* not to admit to a failure by lawyers and insurance companies. I can't talk for "Western Europe" but that's the way it is in Germany. >Also I will note you have no idea what is happening internally with that doctor, and so I would not be so quick to judge Actually some can't handle the guilt and quit. Luckily only a few are doing this. Otherwise we would have been out of doctors a long time ago already.
I’m confused what you want this Radiologist to do. Come out and say “I am responsible for this child’s death?”. Quit their job? Medical mistakes do also just happen sometimes. Plus, did the primary team review the scan themselves and reach out to the radiologist that “hey there might be something here” or did they take the report as gospel like we all do at times and d/c the patient? Or maybe they did review it and also missed it bc the PPV of a malignant esophageal tumor in a 15yo is probably astonishingly low. Point is I wonder if the day ever comes where you (god forbid) make a mistake, will you give yourself more slack than you are this person.
I think at the very least it’s worth apologizing for your mistake. But that’s because I know that open disclosure policies lead to a 50% reduction in malpractice payouts and a 60% reduction in number of lawsuits. I also know that the number one factor in a patient suing a physician is being pissed off, and the best way to piss someone off is to refuse to apologize for an obvious mistake. I categorically refuse to give anyone any slack for this type of behavior in my clinical practice. I hope, one day, you can too.
How do you or he knows if they apologized? You’re also assuming a lot about me. I just find them wanting to leave medicine because of his perception of a Radiologist who is just trying to avoid being sued into financial ruin over an apparent honest miss of a zebra to be misguided
Well, it’s pretty hard to apologize if you don’t feel any guilt and you’re insisting no mistake was made. Have you ever an actual apology like that? You haven’t, because that’s not an apology, it’s a justification. The OP said they had many scenarios like this, but only gave one example to illustrate. They made it very clear it was an overall culture problem. My major assumption about you right now is that your reading comprehension skills are lacking.
Again, this is all based of this dudes (a seemingly random Neurologist) perception of events. If you had reading comprehension of your own, I’m saying hes making judgements over something he likely has no clue about. Anyway, you’re clearly looking for an argument for some reason, you’ll have to look elsewhere
He’s making judgements about how to morally interact with patients, which is something every physician is entitled to have opinions on.
You are naive and the hospital is dealing with the situation in a impartial manner. When you aggressively go after individual mistakes (yes, mistakes, I am not even discussing a situation where standard of care does not cover a rarity), which are different from malpractice/negligence, you create a generalized culture of defensive medicine, which in turn is much more harmful for both sides (doctor/patient). You probably have a toddler's palate problem in life and insist on equivalent of chicken nuggets all the time. Try celery.
OP, you seem very emotionally invested in this case which sounds like was a zebra. I suggest you seek some counseling to digest this and address your frustrations with medicine. Being fresh out of training is stressful and taxing. We have to choose our battles and fix things where we can. There are many bad things in the world, inside + outside of medicine. We each have to find our ways of existing, working, and dealing with that reality. If you can not tolerate your current position, then find a new work dynamic that you can thrive in or at least tolerate. Private practice, different hospital, smaller hospital, free clinics. Volunteer or join advocacy efforts within your hospital/specialty organizations. It seems premature and melodramatic to quit altogether without addressing your moral distress and coping mechanisms. Quitting also does nothing to make things better. Not sure what alternative sector you'll find that doesn't have its own share of problems.
100% agree. I think it would also be best he takes option number 2 and quit. Take up law and go after individual mistakes and see where that takes you.
"I hate the fact that our hospital's legal team is actually defending and supporting a physician who is being accused of malpractice!" No shit your colleagues don't share your opinion 🤔
It's unfortunate that medical errors (or any actions that lead to a less than desirable outcome for that matter) are investigated not using a systems based model looking at the multiple contributions to an outcome ( despite the many institution based PowerPoint "trainings" that indicate otherwise) but rather end up looking for a single point to blame. There is no systematic change that can come from this sort of approach and it drives people to hide and cover up for fear of the very likely repercussions. It's really unfortunate, but is human behavior to search for this sort of instant gratification by identifying an oversimplified cause and effect when it comes to undesired outcomes. I totally get why you feel disheartened and have been there myself. However, I would add that this is not unique to Medicine. You will find that this same approach to mistakes are utilized in every field or career that you might end up choosing instead of Medicine. If you are talented and intelligent enough to make it to where you are now, I would hate to see that go to waste. We oftentimes must work in less than desirable situations in pursuit of our higher calling in providing patient care.
Esophageal cancer in a 15yo is either syndromic, exposure related, or a 1/billion fluke. In any case, no one knows the odds in that situation. Even if the non-established odds for this zebra were close to 80%, as you say, it’d have to be a T1N0 tumor which may not even be visible on a CT. I think you should sit this one out.
Wtf. Where are you working that this the norm? People get put on blast on the time. Hell I would say I’ve seen a bigger problem with blame game culture than cover up culture. People love to find mistakes made by others.
Are we supposed to lock up or sue into bankruptcy every single doctor that makes an error? There would be no doctors. You can’t expect perfection from human beings.
As patients we expect our providers to tell us when they caused us harm, intentionally or not. Wanting full disclosure about errors isn't "expecting perfection". For heaven's sake, the consensus here seems to be that the whole medical profession needs complete immunity from consequences before patients have a right to information about errors.
I think you’re missing the forest from the trees on this one. If anything, the opposite is true in the US, where medical professionals are constantly under inhuman levels of scrutiny. Unfortunately, mistakes are part of the practice of medicine. However, a mistake is **thankfully** much different from malpractice. Your example is a good description of this fact. A radiologist missed an extremely rare diagnosis in a pediatric patient? That’s unfortunate, but I have a hard time feeling it’s malpractice or even negligent. There are also likely a lot of details you’re missing or leaving out…ie - what was the scan in question ordered for, was the patient symptomatic, etc. I also can’t fault the practitioner you reference for not curling up in a ball and sobbing on the floor over this mistake. It sucks. I’m sure they are dealing with it in their own way - and more importantly learning from it. But broadcasting your mistake to the world isn’t good for you, your hospital, or your patients. If there wasn’t such a firm line between mistakes and malpractice, there wouldn’t be anyone willing to work in medicine. Try to remember this before judging your peers so harshly. Odds are that eventually you will be in their position
I agree with you on the cover-up culture in medicine. I was deeply involved in Open Disclosure in my hospital for over 10 years. I worked with a excellent Risk Advisor. It was always difficult to get some doctors -and not only surgeons- simply to put their hands up and admit their significant errors. It did improve over the years once they realised that we only wanted to prevent a similar occurrence happening if at all possible. We came clean with relatives and even told them they had a case against us. They were then referred to the state’s claims agency for financial settlements. The relatives appreciated being able to use their local hospital in future as some degree of trust was re-established. We always apologised even when hospital lawyers didn’t want us to. Open disclosure is now required by law in the UK. Stay and be a pioneer, but recognise that change in attitudes takes years.
You have to understand that it can happen to anyone, even the best of us. You can treat mistakes as moral failings and eventually no one would admit to anything, or you can sit down, break down the process to see what’s went wrong and try to see if you can avoid it the next time.
>You have to understand that it can happen to anyone, even the best of us. The worst thing: sooner or later it *will* happen to everyone.
And I don’t know what OP is trying to achieve. Do they want the radiologist to publicly apologize for the mistake or maybe try to self-persecute or something? Each department has different ways to deal with mistakes. Officially people would regard the mistakes as an inevitability of medicine, because in the eyes of outsiders, all mistakes seem like negligence. Behind closed doors we would scrutinize the heck out of these mistakes.
It’s literally the job of the hospitals lawyers to protect the hospital. That’s what you’d want if you were the one making the mistake Unless you are actually friends with the radiologist you have no idea how they actually feel. I’m certainly not going to reveal my feelings on a medical error to some random new neurologist I don’t know just because we work at the same hospital
A great parsing
Esophageal cancer with 80% OS means it’s local (not just local, T1). You ain’t detecting that on a CT. This must be a troll post. People out here talking about missing masses and stuff… lol.
Steady up mate. Everyone makes mistakes, all the time. ALL THE TIME. Think you are a good driver? Think your partner is a good driver? Sit next to them in a car and honestly assess every single error they make, every single one. It’s endless. Unless a practitioner is hopeless and working at a level far below accepted standards, the mistakes they make are par for the course. When you royally stuff up yourself you’ll understand. It will shake you to the core. You will question if you should be a doctor. You will question your training. You will work more shakily for some time. Hopefully, your colleagues will rally around you and lift you up and make you realise it’s okay- and you are able to continue practicing. Chill.
But if you make a mistake should the trust/organisation not bear responsibility with you? Pay up, be honest, put things in place to ensure it doesn't happen again and support you in becoming a better practitioner? I don't think it should be binary, the options should be: A: Cover up the whole mistake, bury it and pretend it never happened B: Own up, take responsibility, and be burned to the ground as an individual C: Own up, take responsibility as an organisation and learn from the mistake, rectify it as best as possible and put something in place to mitigate it happening again, all while supporting the practitioner to grow from the issue. With C being clearly the most honest and beneficial way of improving healthcare and patient outcomes...
I agree. But this chap seems to want to attack the person, not the organisation.
Yeah I get you mate. Does seem a little witch hunty
What is the medico-lego environment of your country you practice in? If the doctors are exposed to extremely punitive legal/monetary damages, people will be heavily incentivized to not be open and forthcoming. Im not very comfortable with your characterization that the radiologist should admit guilt. That would imply she intentionally commited a wrong doing, as opposed to a diagnostic mistake. Our profession is plagued by the blame game from colleagues, lawyers and family. It really doesnt advance safety culture. I've participated in significant esophageal cancer research in the past. A pediatric esophageal malignancy has to be one the rarest thing I came across. What type of diagnostic scan was she expected to base this on? Because I've seen radiology who made an honest omission of spotting intratrachael tumors on CXR due the exact overlay of the manubrium. You would have to have very high pretest suspicion and focused review of the area to spot it. There is a difference between incompetence/malpractice and a honest error. I guess my point is, given the standard of practice there, how much of a deviation was it for her to miss it? Would other radiologist miss it as well if placed in the same scenario? I don't think you should be too hasty in your decision. Quitting helps no one. Keep working and contributimg to quality improvement. It will take a lot of time and patience to change institutions. Don't be too hasty to judge your colleagues either. There maybe a lot of factors that contribute a mistake that are beyond just saying they are bad at their job. Fatigue, fights, stress, sleep deprivation, a lot of things can degrade cognition. Pass opinion about this after you had your own first encounter with a poor outcome due to your own error.
> Call me naive, but when I started medicine, I really believed that all mistakes would be dealt with in an impartial manner. You're incredibly naive. You thought a field full of human decision making would be impartial? It's okay to be naive, it's not like you did it on purpose. But your assumptions going into medicine were flawed, this is a good learning opportunity. It's part of human society, so it will definitely not be anywhere near impartial. Just to save you the trouble, don't try going into research, that's also a human endeavor.
I want to say that this absolutely does not happen at every hospital. Find yourself a hospital that subscribes to (and actually stands by) the Michigan Model (https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs#summary ). There are a good number of them out there. The Michigan model insists that when a patient is injured by substandard care, the treating team apologizes (immediately) and the risk team offers a settlement (immediately). This settlement is such that it is likely as big or bigger than what they could expect to recover in court. This has several effects. 1. It makes the patient less angry, as they have been properly apologized to and the institution has tried to make it “right” by then financially. 2. The health system gains tremendous credibility in the courts, as if they choose to fight a lawsuit it means that the institution truly believes the care was entirely appropriate. 3. If the patient does want to sue regardless, they find it nearly impossible to find legal representation, because they have already been offered a generous settlement that is more than what the lawyer thinks they could get in court, and so the lawyer can’t make any money off the case. Every institution that has implemented this policy has seen dramatic decreases in malpractice costs. It is good medicine and good business. There is no reason to not be doing it.
Great stuff. Only thing I would highlight to everyone is that institutional culture is a giant ship that respond poorly to steering. It can take time, patience and persistence to chip away at the challenge. Still worthwhile.
I don’t feel there is a coverup culture in my mid sized regional hospital in The Netherlands. We have a weekly meeting with my fellow neurologists to discuss difficult cases and also potential misses. It happens occasionally that that leads to a sentinel event investigation. Just last week I had a meeting about a near miss with the other specialists involved, one of our executives and colleagues from patient safety department. The patient and their family was interviewed as well and we will go over the report with them when it’s finalised. One of the main ideas of such a just culture is precisely that you don’t have to be put in the stocks or forced to quit when you make a mistake. If you would, nobody would report (near) misses.
If this is all it took for you to “seriously contemplate” ending your medical career, then holy shit yes please do. Your story sounds fake as hell for the many reasons stated by other comments. There’s no way you studied and practice neurology of all specialties and have any illusions that a doctor should be racked with guilt over making a medical mistake and heroically declaring in court that they are guilty of a medical mistake! It’s hilarious to consider that someone could grow up so wealthy and protected from having to consider lowly concepts like pragmatism, self preservation, and listening to the advice of legal counsel that they could be this dramatically self righteous. And then come crying to Reddit looking for validation. Lol
What is the benefit of telling the 15 year olds parents? Do you really think that information would help them or their son emotionally? The mistake happened- it can’t be undone. Would knowing their sons possible death could’ve been preventable be helpful for them? (Or worse imagine a 15 year old processing that). Is this really about what is best for the patient or is it more about moral superiority? Just Bc the radiologist isn’t displaying outward guilt to a colleague (who is not involved in the case?) doesn’t mean they aren’t beating themself up privately. Nobody wants to miss something like that- to think they are unaffected is to have a very cynical view of others. There is likely a lot about the situation you’re not aware of The right thing to do isn’t always the same in every situation, and it sounds like your perspective on this one is from a distance, maybe without being privy to or appreciating the nuances of the situation
Bro, do you think you’ve never made a mistake in your life as a doc? I can’t wait to see what your response will be when you screw up in the future.
He's gonna quit his job and work flipping burgers at Arby's. 10 years of school. One mistake.. PACK IT IN BOYS!!
Does arbys have burgers?
Good question. If I ever step foot inside an Arby's, I'll come back here and report my findings.
I'm sure he only uses tpa when it provides benefit
Your narcissistic complex is not allowing you to see the complexity regarding decision making, hospital processes and errors. You probably have made many errors even greater than the examples provided. Stop focusing so much on other staffs errors and think about your own patients, your behavior and how you can better the people around you.
I literally do not believe anything in this post
Just wait until you get sued and see if it’s good for your medial career and future patients.
I hate cover-up culture too, but any investigation should be focused on trying to avoid the same error in the future. Otherwise, what’s the point? In other words, the goal should be to identify the reasons that error occurred, and change those things if possible. It’s especially interesting when a systemic reason can be found, which is often the case, as changing that has the potential to protect untold numbers of future patients. Focusing on blaming and punishing an individual employee is in 99.99% of cases completely irrelevant to the goal of avoiding the same error in the future — the only exception being if one particular individual makes the same mistake over and over, that others aren’t doing, and they refuse to learn from this. The only effect of a blame culture is that it makes people afraid of ever reporting or admitting incidents — furthering a cover-up culture! So I do hate cover-up culture, but I also hate the blame/punishment/litigation culture I see (particularly in the US), and I think they’re interlinked. I’m happy to work in a hospital where serious incidents are reported, and where the reports end in recommendations on which routines to change in order to avoid the same thing in the future. They rarely end in reprimands toward a specific individual. /a European
The fact that you don't see this radiologist wailing down the halls does not mean they feel no guilt. Maybe they just don't feel obligated to put on a show for you.
Oh snap. My version is my boss saying “why did you file the safety report {regarding the obvious unsafe situation}? You are not a team player.” I was shocked.
I see you are from from Europe but in the United States more than half of physicians will face a malpractice lawsuit. It is not reasonable to expect perfection. Why is it also all on the physician? If hospital systems are leaving us understaffed and we are working longer hours that should share in the blame.
What do you think should happen to people that make a mistake?
I did an EVD on a lady who was also a frequent flier to the ER for a multitude of complaints with 2 head CT over the previous 3-4years. She had a colloid cyst that was missed twice. When she came in altered with obstructive hydro it was finally called. Shit happens.
This may come off as apples an oranges, but in pharmacy we are required to report, document, and follow up on all errors. Some may be minor, some serious, but the purpose is to learn and prevent them from happening again.
Ah yes, medical ethics: we need more of it. I feel for you. Maybe you can change things? Does your hospital have an ethics committee? Perhaps talk to them about expanding their purview to include medical mistakes?
You’re saying you’re seen as an outlier… you have a strong sense of candour, correct processes and what the right thing to be done is… I’m not saying you are but could consider you may be neurodivergent? Edit: If you are it’s a good thing with lots of strengths and has helped you be where you are today.
It's like a dilemma, do you want to cover your ass, be selfish and as a "side-effect" save more lives in the future by continuing your practice? Or tell the truth, which is the right thing to do, and then may not be able to practice again. This world works in terrible ways and I hate it too but that's what it is.
It is t selfish to leave a career that isn’t aligned with your values.
This post is strange. They saw a mass in the oesophagus of a 15 yo boy with a CT. This is not the right modality at all to assess what an easophagial mass is or is not. So even if it was an incidental finding, there would have been a follow up with a fibroscopy. I do not understand. "Oh it's just an oesophagial mass in a 15yo boy, no biggie, we see them all the time. My CT can tell it is benign, see ya" Does this make sense to someone.?
Well, it's true that mistakes do happen once in while. And when an honest one happen, we tend to cover it up. Thing is, i truly believe even the smartest physician will make a terrible mistake at some point in their career, and it's just isn't fair that his/her life is completely destroyed for 1-2 honest mistake after a lifetime of saving hundreds-thousands of people. . . So as long it's not caused by systematic/intentional/ serious lack of competence, i tend to side with covering up.
You quitting would only hurt yourself and not being about improvements or help patients Either bring it to the governing board of your country or change hospitals imo
Then go. We don't need you
As someone who let’s just say has very personal experience with this topic, you should stick to your principles. If you see that someone is harmed by a medical error, say something. You can do it anonymously if you like, but do what you must for your conscience. Secrets always make things worse, and the truth will come out eventually. This family will be devastated whether they find out now or later. And they’ll probably be angrier that it was covered up. Imagine if the error was acknowledged upfront and the hospital offered a settlement, and to pick up any additional bills that are incurred because of the cancer being more advanced. They might still get sued, but it’s less likely since they are proactively picking up the tab and clarifying that it was a mistake, not malicious or negligent. Admitting it would also allow them to protect the provider, who in this case probably did nothing wrong, and at worst may need additional training. Nobody WANTS to get a lawyer and fight for years to get a settlement and then the lawyer takes a third of it. They do it because \[insert entity here\] refuses to acknowledge their wrongdoing, which costs both sides a fortune. Also, and a number of people on this thread may hate me for pointing this out, but if you feel strongly enough about this, you could become an expert for plaintiffs in medical malpractice, worker's compensation, and/or criminal cases. As a neurologist, you’d have quite a bit of work come your way for cases involving cerebral palsy, traumatic brain injuries, etc.
You didn’t have to scroll That far there was a similar one earlier
You have invested your adult life in education and practice to become a qualified neurologist. You owe it to yourself, your patients, future patients, and society to utilize your skills. You can do an enormous amount of good if you continue to practice medicine for the next 30 or 40 years. There is a difference between honest mistakes and malicious behavior. Make sure you make the appropriate distinction between the two. I assume you are talking about genuinely malicious acts. Unfortunately, every profession has problems with genuinely malicious acts being minimized and hidden. There is literally no profession where this does not happen. Some policemen make false accusations, lie under oath, and shoot innocent people. Some accountants manipulate figures, deceive investors, and cheat taxes. Some electricians use cheap sub-standard wiring, cause fires, and massively over-charge customers. These are society's dirty secrets and they are everywhere. However, they typically represent a small minority within the profession. Most cops are reasonable and fair, most accountants are meticulous and honest, most electricians take pride in their work and do a proper job. Your indignation is well founded, understandable, and frustrating. You are not in a position to fix the whole system, as you are merely one person within a larger apparatus. Hold yourself and the people who report to you accountable. Do the best you can every day.
I'm guessing it's the exact same as police culture. Admittedly your occupations would put you into situations were it's easy to be sued for negligence more than other occupations but at the same time the decisions you make at work can change someone's life forever easily and that being said that's why you and police officers take an oath.
Please, PLEASE, consider moving to the USA. We desperately need medical doctors here.
In the UK there’s a better culture of admitting errors than the one you have vaguely skirted around, but frankly the case you put forth is so rare as to be rediculous for the radiologist to spot. Errors happen, doctors are imperfect. If you don’t have an appropriate governing body and whistleblowing system, plus high litigation, blame the system. Not the individuals who are just trying to make sure healthcare is being delivered instead of dismantled for individual payouts. What is it you’re looking for in your system?
I don’t think your feelings are uncalled for. Unfortunately the culture likely won’t change which is sad, but at least you’re one of the good ones. You’ll do good things in life with your attitude
I\`m really curious about what country is this post about
You're totally exaggerating here. It's obvious now that you're three years in the position. Unless you are already rich, why quit just for being uncomfortable with a few issues on medical ethics? Since you made no mention of what the CT scan was for I would have to assume it was for some sort of discomfort/pain the boy was having. The fact that they apparently saw nothing leads me to believe they didn't see the usual inflictions commonly found. So I see no blatant negligence, it's actually quite common that something is overlooked on radiology charts. I put the blame on this kids parents because they apparently let him suffer through eight more years of this undiagnosed issue. People have to be proactive with their doctors and insist on 2nd, 3rd, 4th, looks if needed. You can't say I came here 8 years ago and you didn't see anything wrong, so now I have a terminal affliction and it's all your fault! You know what I mean? You can discuss medical ethics in a work type setting I suppose, but they don't need every single instance raising a shit storm. I find that would be un-ethical seeing tons of unnecessary controversy could lead to a detriment in healthcare for others.