Recently read this article on KevinMD.com about a 3rd year medical student risking his ego and speaking up for a patient he felt was in danger. While this story had a happy ending, you can see how much internal struggle Andrew goes through to request and then finally demand help. With an average of 1,000 patients dying a day due to medical error we have continue to ask why new medical and healthcare professionals are being trained into a system that has serious consequences for “wasting staff time” against saving patient’s lives.
Consider this story from 3rd Year Medical Student Andrew Ho:
As a third-year medical student, we are considered to be the bottom of the totem pole in the hospital. After spending the first two years studying for our Step 1 boards, the only clinical medicine we know comes from what we have read and heard about in books and lectures. Our questions are frequently met with laughter or are berated for lacking common sense. And in the fast paced world of the ED, nobody has time to answer stupid questions. “His nurse probably knew he had a head laceration,” I reasoned . “There’s no need to alert anybody. He’s not even my patient. The ED staff is more than capable of handling this.”
A minute passed. And then another. Nobody came by to see this patient, who continued to bleed. I hesitated against speaking up, since we were in the middle of a trauma. But I couldn’t wait any longer. I asked an ED nurse if he was her patient. “No,” she said before hurrying off. I told another nurse that a man was actively bleeding and he said, “Go get his nurse!” After a few more failed attempts, I had had enough and pulled aside my resident. “I think this man has been bleeding profusely for some time. What should we do?” His eyes widened as he saw the amount of blood that had soaked into the sheets. He reached for a pair of gloves and told me, “Get a suture kit, now!”
I hurried off to the supply closet and came back with a bunch of supplies. The patient was now writhing in pain as we dug around with our fingers inside his wound, trying to locate the bleeding vessel. We liberally injected lidocaine before exploring deeper with pickups and clamps. I tried to dab away the blood so that we could see into the laceration, but blood instantly filled the cavity. We couldn’t localize the source of the bleeding and our attempts to blindly clamp the vessel were met with frustration. Anytime we thought we stopped the bleeding, blood would spontaneously squirt out, like water spewing from a compressed hose. When the blood splashed up against our glasses, my resident and I looked at each other and knew we needed more help.
We wheeled the stretcher out of the back corner and into the trauma bay where we applied Yankauer suction into the wound. This helped us visualize the lacerated artery quickly. We clamped the vessel to stop the bleeding and tied it off with sutures. Given the amount of time he went unnoticed, we estimated that that patient’s estimated blood loss was anywhere from 500-1000 mL and gave him IV fluids to help replenish his intravascular volume. When the chaos had settled, a very surprised ED attending entered the bay. “He was playing on his cell phone just a few minutes ago!” she exclaimed. She thanked us for our work and my resident commended me with a quickly muttered, “Good job.”
A quickly muttered “good job” and no department follow-up or debrief? This was one time a medical student stood up but what about the next time his counter-part remains silent? Check out yesterday’s story on how “silence kills” in healthcare and learn about a book called “Beyond the Checklist” that shows us how we can fix this systemic problem.
Read the full story on KevinMD.com
