Association of Family Practice PAs & NPs

Communication and Dangerous Medical Errors

Posted 2 months ago by Stephen Quick

Communication and Dangerous Medical Errors

Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus

Communication is as old as the human race and has always played a part in our lives: from early writing on the walls of caves in pictures, to smoke signals, the printing press, Morse Code, the welcoming of Alexander Bell's telephone and, of course, all of the enhancements that we have today, including that annoying cell phone with its robocalls. The purpose of communication is to share a message and to get a response. The key to communication is not mere hearing, but the focused act of listening, responding, and returning information. How often do we go to a store, give an order, only to have the clerk say, “What did you want?” They have not listened to what you ordered.

This is unacceptable in a medical practice. Just yesterday, as I began to write this article, I was informed of a medical error which caused a patient a greater morbidity risk because the message that was given was not relayed and the patient trusted the nurse who gave the response. We all know Mrs Jones; Mrs Jones called the gastroenterologist three days ago with the complaint of minimal left lower quadrant pain, severe bloating, gas, was afebrile and had unusual bowel movements. Mrs. Jones called her doctor when she realized that she was not healing spontaneously and needed the attention of a specialist rather than running to an Emergency Room. The nurse said the doctor was booked, but that she would double her up sometime that day or the next day and to wait for a call. The call did not come that day or the next. When the patient was finally seen as an emergency, she was beyond Flagyl and Cipro as she now had a perforated diverticulum. If the patient had been seen as she had been promised, the need for emergency surgical intervention might well have been averted.

This is only one of the hundreds of errors that can occur when employees in our offices drop the ball or when we do not have protocols in place. Every time that a PA or an NP orders blood labs, urine, radiological studies, special consultations or has a patient that has been discharged from the hospital, they should be notified by the provider or designated office person as to the results and what they may mean. Telling a patient that their WBC is 16,000 is not the same as saying that it is abnormally high and indicates an infection. When a patient reports a problem or calls to say their blood glucose is 50 or 350, these are examples of hypo and hyperglycemia and they will need to speak to a provider for directions and follow-up. All responses need to be placed in a log with the signature of the person making the call and what they told the patient. Hospital discharge patients require the same procedure to assure them that you are concerned and that they have had their questions addressed. These are written procedures and protocols and your health care system probably has forms for this for their own follow up. What if your office workers are not diligent to maintain this type of record? You, as the provider or owner of your practice are 100% responsible and, therefore, you need to have the proper liability insurance. You will also need to discharge that employee from your practice setting. 

What is the best type of insurance to have for these potential problems as well as the many others that you may encounter as you practice medicine or nursing? My suggestion would be an occurrence policy, and not just any occurrence policy or one from your healthcare system, but a personal liability insurance policy that specifically names you as the covered and owner of the policy. What company would I choose? A company with a reputation for honesty, paying their claims, securing excellent attorney’s and having the ability to pay claims without bankruptcy. I would choose a company called CM&F, Personal Liability Insurance experts with a 70 year history of excellence and an A++ (Superior) rating by A.M. Best. Why this company? Because it is proven and has cared for nurses, PAs and NPs throughout its history and is a committed family-owned business.


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