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Reviewing Cases--2 parts--longFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Wed Aug 11 20:55:35 2004
Fascinating thought (forgot who) about incriminating ourselves, as we profit from case review and testimony. I am guilty of reviewing 2 to 4 defense cases/year for payment. I've looked at a handful of plaintiff cases, and declined review--usually they were not good cases. Case reviews are educational to me on many levels, especially demonstrating: 1. The need to document. 2. No good deed goes unpunished. 3. Listen to the patient. 4. If you order a test, get the result. If the result doesn't matter, why do the test? Garry Side story--long: Multip calls in the wee hours in labor--was 4 cm. in office the day before, and arrives fully dilated. I am at home because I didn't think (wasn't awake, frankly, to put 2+2 together)to simply head in concurrently, nor did I remember to ask her GBS status (positive). L and D calls 45 minutes later--Nurse A says she's complete, get here now, phone clicks. I arrive 25 minutes later, patient huffing and puffing, undelivered. AROM and delivers in 5 minutes or so. As I'm literally sitting there, nurse B asks, "do you want us to start the Penicillin?" My answer--Please do so now. After delivery, at the desk, I tell nurse A (nurse B is listening) that: 1. Sorry I didn't think straight and come right in. 2. Sorry I didn't remember/ask the patient about GBS. 3. Nurse A knew she was GBS positive and should have asked me on the phone about antibiotics, if not simply have started them per protocol. Nurse A says: 1. It wouldn't have done any good. 2. We wouldn't have gotten 2 doses in, so the nursery still works up the baby. 3. We (nurse A and B) talked about it and decided not to give it, but to ask you when you got here. Nurse B pulled me aside and said she should have started it. My point to Nurse A, who simply didn't understand this, was that she did not perform her duty correctly in that she had the opportunity to inform me of the GBS status. While her logic (1 and 2) may be correct, it was not her decision to make, and that we wouldn't have a leg to stand on. Furthermore, even if the drug wasn't immediately available in L and D (it is), we still need to do the right thing--order it, try to get it, and administer it. I told her that by reviewing case, I've learned that we must do what is right, document it, and when we don't, we can lose. The best that we can do is (thanks to Murray Freedman, MD) BREAK EVEN. Nurse A never got it, never has, never will. I concluded by apologizing but pulling rank by necessity, and saying "I'm the doctor, you're the nurse, so I'm sorry but I need you to do that which I ask." Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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