In the NYTimes:

It was the middle of the night, and Laura Silverthorn, a nurse at a hospital in Washington, knew her patient was in danger.

The boy had a shunt in his brain to drain fluid, but he was vomiting and had an extreme headache, two signs that the shunt was blocked and fluid was building up. When she paged the on-call resident, who was asleep in the hospital, he told her not to worry.

After a second page, Ms. Silverthorn said, “he became arrogant and said, ‘You don’t know what to look for — you’re not a doctor.’ ”

He ignored her third page, and after another harrowing hour she called the attending physician at home. The child was rushed into surgery.

The article continues with a profile of the steps medical schools and hospitals are taking to encourage non-attending physicians to speak up, thereby reducing the frequency of commonplace, preventable malpractice like medication errors and wrong-site surgery. 

PalMD at the denialism blog thinks that’s barking up the wrong tree:

Quality medical care depends on many things (not the least of which is access, but that’s a topic for another time). It should be made to depend on individual personalities as little as possible. Let’s look at two areas where we can improve medical care.

Electronic health records (EHRs) would go a long way to helping reduce errors and make continuity of care more, well, continuous. At this point, however, there are no national standards for EHRs, nothing that requires them to be able to understand each other, nothing that subsidizes the huge costs to physicians and institutions for installing and implementing them.

Quality care isn’t about mistakes made by and to individuals. It’s about creating a health care system based on evidence. It’s about making data available and using it correctly. It’s something we can choose to do. Or not.

Problem is, the more automated a system becomes, the harder and less likely it is to be overseen properly, and the greater the damage that can be caused by a single malfunctioning actor.

Like a recent trial I had where a resident, after consultation with the pharmacist (and not the attending), verbally ordered a preoperative antibiotic with a high likelihood of cross-reactivity instead of an alternative preoperative antibiotic with no likelihood of cross-reactivity. (Adding insult to injury, the attending surgeon actually preferred the latter, non-reactive antibiotic)

None of that occurred on paper, despite hospital protocols requiring all orders be documented and all resident orders by co-signed by the attending. Not at all surprising — every week I review cases where a nurse or doctor just plain didn’t follow protocol, despite all kinds of checklists and automatic warnings.

Don’t get me wrong: I’m a big fan of using appropriate checklists like the Keystone program and using electronic health records. But increased automation is not a solution by itself — you still need to encourage the same type of regimented-but-open discourse that, e.g., military units and athletic teams use to control and to react to dynamic situations.

If you were injured by medical malpractice, contact a Philadelphia medical malpractice attorney.