Brake Repairs and Healthcare – Misdiagnosis versus Pure Incompetence

A few months ago, my car needed repair work so I took it to a neighborhood auto mechanic shop. Over the last two weeks when I applied my brakes, there was a rubbing noise that became worse each day I drove the car. The mechanic listened to my story and after looking at the brakes, explained the pads had worn down almost to the drums, and would need to be replaced. He and his team seemed confident and competent – he said he would get the brakes back to new again.

When I picked up my car and was driving away, I noticed the brake problem seemed to be worse. The noise I now heard was even louder than before.  I returned to the mechanic’s shop–another unplanned stop in a busy day for a problem that was supposed to have been addressed. The mechanic acted surprised, and said I would need to leave my car at the shop another day so he could see what his “younger” mechanic had missed. Frustrated, I left the shop thinking about the inconvenience this incompetence had now caused me.  But what happens when incompetence like this occurs in healthcare….

Which brings me to this next story. My youngest daughter, who is finishing her last year of college, called me yesterday. She was very upset about something that happened this past week. Being her Dad and also a physician who has spent a career working in quality and safety, I was a reasonable target for her to vent her frustrations since they stemmed from what appears to be, at best a friend’s misdiagnosis, and at worst, pure medical incompetence. The ripple effect of a medical error unfortunately no longer surprises us, but pure incompetence by a caregiver is also too common and I share this story because all of us should demand better from our profession.

A few months ago, my daughter’s good friend went to see a physician because she had missed two periods and then had an episode of abnormal bleeding. The physician explained that my daughter’s friend had been pregnant, but had experienced a spontaneous abortion. He told her that she would return to a normal menstrual cycle in the next month or two. Two months passed and she continued to feel “not quite right,” and when her cycle did not return to normal she returned to see the same physician. After an examination, the physician now told her there was a grapefruit-size cyst on her ovary, and that she needed to see a surgeon. The young girl was finally able to see the surgeon after another month of waiting. This time, however, the examination resulted in a very different finding. The surgeon sat down with my daughter’s friend and explained that what the first physician had thought was a cyst, was really a baby. He had heard a rapid heartbeat during the exam, and by his estimates, she was over six months pregnant.

In the matter of one short conversation, this young girl’s life had drastically changed, as did the lives of her family, my daughter and a child yet to be born. If she had known she was pregnant four months earlier, she would have had choices–stop drinking with her friends on the weekend, take vitamins, eat healthier…all things she had not been doing but immediately began once leaving the surgeon’s office. She also has decided to drop out of college with less than one year left so she can prepare as best as possible for the changes that will now be coming her way. She moved out of her apartment and back home with her parents, knowing finances responsibilities are much different than just a day earlier when she was enjoying being young, hanging with friends, working a part-time job, and trying to finish her last year in college so she could get the degree she had been working so hard to complete.

The healthcare system exists for many reasons–but at a bare minimum, physicians are required by an oath to “first do no harm.” Here is a glaring case that has the potential to harm at least two people, and has changed the lives of many in this girl’s inner circle. As 20-somethings find their way in the world, mistakes are common and often the way in which many learn lasting life lessons. I know I made my share of mistakes growing up. Safeguards like healthcare are supposed to be in place to help mitigate some of those mistakes–not compound them–and seeking help from a healthcare provider should not result in greater harm as a result. In this case, because of what appears to be pure medical incompetence resulting from one physician’s inability to follow standard of care practices, this young girl’s life, and possibly that of her unborn child, will be changed forever. We do have a medical error crisis, and many caregivers are working very hard today to make care safer for our patients but we also need to address competency and critical thinking issues. To do this, it will take more than teach-backs, checklists and timeouts…

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