Would you list health care acquired infection or central line acquired infection or just the infection type for example

I don't do ICU care and don't do emerg anymore. So the certificates I do are pts that die on ordinary inpt wards, nursing homes and people that die in their own home (expected and otherwise). Death certificates are a big issue as you point out. There are many ways you can fill one out with the same set of circumstances.

In our area due to decrease in gov't funding the coroners are under pressure to not investigate deaths that happen outside of hospital. And we have a shortage of coroners. So if a 55 year old male dies in bed at home who has hypertension and is a smoker high likelihood it will be attributed as an "expected death likely an MI" and no post mortem. It really is quite astonishing.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

I'm a little surprised at all the hostility to the OP, not to mention you.

My experience is that self reporting doesn't work, morbidity and mortality conferences whilst of interest to clinicians are insufficient in addressing process failures and that what goes on a death cert may have little to no bearing on the root cause. So I'm not sure I've ever heard of patient death being put down as poor clinical practice for all sorts of obvious and reasonable reasons but the consequence is that correlating a set of actions on hospital with adverse impacts on patients is very difficult.

Root cause of what? I think he was just saying that medical errors are a problem, here's some stories. Not claiming that he's going to fix all of health care.

That sucks.

Three day ago I saw a pt of mine who presented with dizziness, weakness to a hospital well north of me. He was discharged with postural hypotension secondary to medications and diabetes. I read the note. In postural hypotension the blood pressure goes down when you stand up. They document his bps going up slightly when he stands up. WTF? I think they just wanted to get him out of the hospital. If you don't know what the pt has okay to say so.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Me too... wondering what the exact definition/criteria for " medical error " is.

The problem with medical errors. Is you’re always wrong until you’re right.

I had a tear in my left hip labrum. It took a year+ to diagnose. The tear showed up on the MRI, but that isn’t always conclusive, and with the pain I was in they thought it could be my back, treated that for awhile and went to a different doc and he said it’s definitely your hip. We fixed it and it’s all good. Both of the doctors I saw are two of the best for that surgery in the Denver area. Not every presentation is a straight line a to b conclusion. People don’t get that.

Not true. Basic processes like inserting catheters, not managing patients I such a way that minimises pneumonia are avoidable

Errors such as misdiagnosis may be more complicated but there are thousands of avoidable uncomplicated process errors that occur every day

Yeah, that's the issue I've had. A sort of latent hostility to admitting lack of knowledge, and an affinity towards suggesting it's "in your head" to explain a discrepancy between reported issue and diagnostic information. Which I'm sure is *true* at times - people abuse doctor visits, drug-seek, etc. But I wish they'd just be more transparent about it.

That really was the key to finally finding a way through. If they just throw something out when they don't really have a clue and just want them out of there it makes the patient stop looking because they think it has been solved.

The other part that really complicated it was the need for someone to take ownership of finding the issue and driving it through the system. Even in the end when we were going through Ohio State's neurology department, we saw a different neurologist almost every single time. It was only when our very good GP decided that she was not going to let it go that we got there.

Two neurologists specializing in MS were really the worst of it. If a symptom couldn't be caused by MS, they dismissed it as unrelated. Mouth sores, skin pathergy, etc. One scoffed when asked about low albumin and literally said, 'well, when you figure out what is behind that let me know.' Of course it was caused by inflammation in the liver caused by untreated Behcet's.

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I'm beginning to think that we are much more fucked than I thought.

You might have misread his statement. It was "Not every presentation is a straight line a to b conclusion."

You seem to think it was "No presentation is a straight line a to b conclusion."

That only came from one person. Who appears to work in the medical field. And also thinks the patient should check their work on Google.

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I'm beginning to think that we are much more fucked than I thought.

I thought Nova calling him an "ambulance chaser" was odd. Ambulance chasers are chasing money. The OP seems altruistic. It's fine to suggest that what he's doing is just story-telling and won't have any positive effect. But "ambulance chaser" is purely pejorative.

He said you're always wrong till you're right or vice versa

My point was that we are in general pretty crap at the basic stuff: inserting lines and doing preop checklists let alone the complicated stuff. That was all

I don’t disagree but its still the same point. Even if you do everything “correctly” with a procedure like inserting a catheter or how you manage patients it still may end up being wrong.

I don’t really like the word avoidable for stuff like this. You have humans training someone to do the process, you have humans doing the process and you have a human who is getting the procedure done to them. They can be minimized to some extent but they can’t be avoided.

Patients don’t want to accept that there is a delta from perfection that will occur because humans are doing the process.

I agree. I think it's just about reducing variation

Or the last guy to see the pt was the smartest one. Or everyone remembers the misdiagnosis not the correct one. When I see 30 patients in a day the one who sticks in my head is usually the one who was unhappy. It is a funny thing. Either way it is a very human process. Imagine if every plane you flew was different. Some things can be standardized but many things not.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

I'm not going to change your mind because I've learned you have 30 years of emotion in this. Nevertheless, since you mentioned me again today I'll say the following:

My point to you, and to those reading your story, is that you seem to look back in hindsight and feel that all of the doctors that got it wrong made a "medical error" (that's the topic of this thread) by misdiagnosing your wife. But you only filled in those blanks after someone finally got it right. The articles I linked were to point out that Neuro BD versus MS is a difficult diagnosis to make, confirmed by the number of doctors you saw who got it wrong.

In my effort to be brief, and a smart ass for effect, I offended you. That was not my intent. But your tact to the story is offensive to me. It is not an "error" to be incapable of finding the correct diagnosis, especially when the diagnosis is a zebra that looks a lot like a horse. I'm glad you found someone good and I'm sorry that I offended you.

I think a big part is patient expectations.

In many cases the diagnosis is pretty easy. A Brain tumor on an MRI.

The problem comes when it's not black & white. In a good number of cases the MD is making an educated best guess. Then it really comes down to persistence and luck.
I'm willing to bet that if JPO's last doctor was the 1st doctor they would have been told MS. The difficulty is moving past the 1st diagnosis when it isn't correct. Some MD's are good at this, others just suck.

Accepted. And I will drop it and not make more comments about you being a Google doc. (see what I did there?)

One of my problems through the whole saga was exactly what someone else mentioned. They didn't know. And they knew they didn't know, but they still tossed something out there. And not in a, "I don't know but it might be something like this" way. But in a 'here is what is wrong' way. In science, and presumably medicine, "I don't know" is an answer. Making up an answer makes the patient stop looking. I call that a mistake, you can call it something else.

Another issue was that two different neurologists made actual mistakes and actually did not follow the standard of care. Other neurologists involved were distinctly disturbed by their actions. We didn't pursue because as you pointed out, Behcet's is hard to spot and pretty rare.

Yet another issue was a young woman being blown off and told she was just stressed. Would a doctor tell a man he was stressed and that was causing paresthesia? That is nuts. She was told she was nuts multiple times by multiple doctors. Until our GP pointed out, even if a doctor thought she imagining some things, it is pretty hard to get your imagination to give you low albumin.

The reason I took offense at you is that you made broad assumptions about what we did and did not do based on a story shortened, as you note yourself did, to be brief. And your last post before this was way way over the line.

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I'm beginning to think that we are much more fucked than I thought.

I don't think jpo is talking about the OP. I was also surprised by the hostility to jpo's story which should be acknowledged as an example of a systemic failure.

In OP's case, coming on here posting links to his own web site, and providing diagnoses like "his head was sinking into his body squishing his brainstem" was pretty much guaranteed to cause some backlash, no?

I've posted my second interview - this time with a man from the United Kingdom:

What does it feel like when you find out your physician has betrayed you?
How do you move forward when you've been denied a diagnosis, denied treatment, and then denied justice?
If you’re Gregory Hartley Brewer, you push to expose the medical errors and public health threat.
https://www.patreon.com/...ory-hartley-27794781

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Advocating for research & treatment for Myalgic Encephalomyelitis (ME).
http://www.meaction.net/about/what-is-me/

"Suck it up, Buttercup"
(me, to myself, every day)