It Coulda Been Me

low_back_pain_trigger_point.jpgRecently, I mocked the medical mistake of a former resident from my program who is in the news for sexual assault charges along with the mistake. The doc in question apparently tried to perform a “trigger-point” injection in a patient’s back, and pushed the needle in too far, puncturing the lung. According to the report, he didn’t recognize his error even after the patient returned to the clinic many hours later in the day. The doc went – himself – to a local drug store and bought liquid morphine for the patient and sent her home.

This is all according to a report that makes no attempt to present both sides of the issue. It only presents the side of the patient, and the doctor’s story could be very different. But aside from my early jump to self-righteousness, I had an interesting experience today in clinic that brought this issue – and my scorn about it – to the fore:

Today, I saw a patient who said her back was in tremendous pain. As I examined her, I found that the pain was located in one single place, making her a good candidate for a trigger-point injection. Suddenly, I realized that this was a nearly identical situation described in the report about this embattled doctor.

I realized right there in the exam room just how easy it is to make fun of people, to criticize their mistakes, to scorn their decisions…and how unfair that is. Thinking through performing a trigger-point on this patient, I instantly worried that I could do the same thing this doctor did. Do I really know how deep to put the needle? Yes, but what if this particular patient has very thin intercostal muscles? Would I catch any warning signs that her lung was punctured if she returned later in the afternoon while I was frantically trying to keep up in my clinic?

Maybe criticizing him does for me what making fun of anyone does for insecure people – it makes me feel better about myself. Maybe I looked at him and thought about how I probably wouldn’t have done something so obtuse. I wouldn’t have dropped the lung…and if I did, I would have recognized the signs and sent the pt. for treatment in the ER. Right? Of course. Right?

The truth is, I don’t really know. Yes, trigger-points are pretty easy. Yes, the signs of a punctured lung are generally unmistakable. But no, I wasn’t there. Maybe her anatomy was strange. Maybe he didn’t communicate well or maybe he didn’t understand well. Maybe x 1000.

Doctors screw up. Nothing can change that – no test, no redundant quality system, no oversight. Docs mess things up just like all humans, just like computers. Standing there looking at this patient’s back, I remembered that every time I make it through the day without a major mistake, I grateful. It’s easy to make mistakes in medicine. For as much grace as I need in this field, I’m amazed by how easy it is to withhold it.

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