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What’s Up, Docs?


Let’s talk about mistakes you’ve made.

Dr. Virus: I think the confession of mistakes is really this perverse macho thing where we’re really talking about how powerful we are. Every time I hear about people talking about their patient they’ve killed, I think about how they’re talking about how powerful they really are and how they can kill anyone. It’s a hazing thing that we all have to kill a couple to show off how cool we are. Still, there’s no question I’ve made some unbelievably stupid decisions.

For example?

Dr. Virus: When I was an intern, I gave someone fluid and put them into fatal heart failure because I misunderstood what to do. He was someone who was destined to die soon—he had end-stage cancer. But I feel like a crumb about it all the time. But I also feel like I hang on to it because it makes me feel like a powerful guy that I killed someone.

Dr. Heart2: I’ve made mistakes where I’ve missed checking a lab result and the patient ended up dying. I still don’t know that a patient died because I missed the lab result.

Dr. Virus: But you still think about it.

Dr. Heart2: I still think about it, but as you go on in medicine and get more experience, you realize you have much less control than you thought you did. I made this mistake as an intern, and I did beat myself up about it.

Dr. Heart1: When I was a resident, somebody with a severe chronic illness came in with kidney failure and severe electrolyte abnormalities. He was being aggressively replenished with electrolytes, his kidneys were not working yet, and now his electrolytes were too high. So I went through and looked for all the electrolytes that were being given through pills, nasogastric tubes, and IVs, but I didn’t see the electrolytes being added through the bag. So I went home when my call was done, and the next day, I found out the patient coded and died. No one knew what happened. They went back in the code labs and discovered that the electrolytes left in the bag had contributed to the patient’s death. My mistake led to that patient dying.

Dr. Baby: I dropped a baby once. The nurses were calling me into different rooms and the baby fell out of my arms and onto the floor. I scooped it up and somebody said I should have said, “Oh, look—just born and crawling already.” The baby was fine, and I made the decision that when you’re operating, your mind needs to be free of all other extraneous issues.

Long Waits
“At the barbershop, they know that every haircut takes X number of minutes. At the restaurant, they know a meal is 90 minutes. But at the doctor, one unexpected problem and you’re an hour behind.”

What are some mistakes you still make?

Dr. Virus: When I try to be nice to patients and cut ’em a deal. Not a financial deal. But when I’ve made mistakes, it was because I didn’t want to hurt the patient. I’ll not get a biopsy on someone because it hurts, and I should have. Maybe someone has already had two biopsies and I don’t want to get the third, but they’re still undiagnosed and the only way to get there is to get the third biopsy. I hem and haw for a while before recommending it because it’s uncomfortable for them and I’m trying to be nice.

Dr. Heart1: Especially for patients you like, you want things to be okay. Subconsciously, you’ll sort of move toward that realm. So you may not order a test right away because, yes, 90 percent of the time that is benign. I don’t see such a problem with ordering tests. Wanting things to be okay because you like somebody is something to worry about.

What’s the strangest thing you’ve ever seen in a hospital?

Dr. Baby: Once I was sitting in the emergency room and a guy came in and I happened to be schmoozing with one of the nurses at the front desk and he says, “I need help,” and there was this buzzing sound and we couldn’t figure out what it was until he went in and we realized he’d gotten a vibrator stuck up his ass. If you ever put anything someplace where it shouldn’t go, always make sure to have a handle. Put a string on it, for God’s sake, so you can pull it out!

Has the threat of malpractice made you a better or worse doctor?

Dr. Baby: It makes us not better but more conscientious—about sending the follow-up letter, more conscientious about calling the patient three times and saying, “Did you get your mammogram?” In the old days, you could say, “Go get a mammogram, here’s the address,” and then the patient has the responsibility for the next step. We’ve lost suits over, “Oh, yeah, she told me to have a mammogram, but she didn’t tell me how serious it was. She didn’t emphasize it.” I think it’s made us a little bit better about follow-up, about trying to nurture patients in the right direction.

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