If you want to join us on our learning journey, remember to subscribe to our iTunes Podcast at: Common Rounds Podcast: FREE ON iTUNES!
Doctors are humans, and humans are not perfect. We will all make mistakes sometime in our life, and because of our job, we can risk harming patients.
The teaching theme this week at university was medicinal safety – teaching us common prescribing errors and bad habits junior hospital doctors often make due to inexperience. Habits such as using abbreviations, writing ambiguous directions, and even bad handwriting seemed were common reasons for medical emergencies to occur. The important thing to remember is that these could all be preventable.
The following is a list of some bad habits that could be easily fixed to prevent patients from prescribing errors.
- Write drugs in their generic (drug) name – don’t write the drug in abbreviations or in the brand name
- e.g 1. How many people know that DDAVP is an abbreviation for desmopressin
- e.g. 2. Cyclosporin (Chemo drug) was accidentally given instead of Cyklokapron (Tranexamic acid used to stop heavy bleeding)
- Use your decimal points carefully – People can lose the decimal point
- e.g WRITE 0.5mg instead of .5mg because people can easily miss the decimal point and administer 5mg
- e.g. But write 100mg instead of 100.0mg because the decimal point can be missed and 1000mg will be administered instead.
- Clearly articulate your dosing directions – spell out your intentions
- Don’t use OD,BD,TDS and instead write Daily, Twice Daily, Three times daily
- If you don’t know what you’re charting, look it up or ask for help.
- There were cases where dosing errors were copied from the previous chart to the next as the doctor just transcribed the drug directions out of uncertainty.
There are many more good prescribing habits that could be found in your local hospital procedure guidelines. If in doubt, have a look there. Otherwise, grab a pharmacist and ask for help!
One very interesting point brought up in class was to use checklists. In certain parts of the world, hospitals are implementing checklists as part of day-to-day practice to reduce preventable harm in medicine. The idea may have originated from airline companies that use checklists as a way to reduce errors on board an aircraft.
I love this idea and it sounds awesome. This is a simple and cost-effective way for doctors to double-check everything is in order before starting or finishing a procedure.
On the other hand, I’m aware that people are against the idea of checklists. Some doctors feel that checklists limits their autonomy, others feel that they have experience and know what to do and thus don’t see the need of it.
This may be the case for some people, but for the most of us errors are bound to be made in busy and stressful situations. It doesn’t hurt to be more careful, especially if the harm goes towards your patients.
Where do you stand on checklists?
“Learning about the significant overlap between the disorders of animals and humans, how was it that I had never thought to ask a veterinarian, for insights into one of my human patients?”
I watched this UCLA Cardiology professor share what she learnt from our veterinarian colleagues. I have to say, I whole heartedly agree.
I’ve got a best friend from high school that is working as a vet, and it’s just fascinating to learn about the similarities and differences between human medicine and vet medicine. Here’s a snippet of what I’ve learnt from him over the years.
Did you know:
- Cat’s normal heart rate is between 140 to 220 bpm?
It will take super human listening skills to hear pan-systolic murmurs and regurgitations!
- Dogs cannot metabolise certain compounds in chocolate, making it toxic for them to eat.
- Paracetamol is deadly to cats.
True story! Seriously, go talk to a vet. You never know what you’ll learn.
Meet Captain Chemo-tox! The guy who’ll probably never be an Avenger.
Superpower? Crazy suit and costume that shows us the side effects of chemo drugs!
Ears – Cisplatin/Carboplatin (Acoustic nerve damage)
Arms, legs – Vincristine (Peripheral neuropathy)
Lungs – Bleomycin, Busulfan –> Pulmonary fibrosis
Heart – Doxorubicin, Trastuzumab (Cardiotoxicity)
Kidneys – Cisplatin/Carboplatin (nephrotoxicity)
Bladder – Cyclophosphamide (hemorrhagic cystitis)
Bone – 5-FU, 6-MP, Methotrexate (myelosuppression)
Thank you… Captain? You made my life just that little bit easier… hmm
Like this stuff? Come like us on our facebook page: www.facebook/commonrounds
We’re learning the malaria parasite life cycle. The level of precision and evolution that the parasite had to go through to develop into this life cycle is just mind-boggling. It is just amazing to learn about. The animation makes it also very entertaining to watch too!
FOR MORE QUESTIONS, COME VISIT OUR FACEBOOK PAGE. WE WILL BE REGULARLY UPLOADING NEW QUESTIONS THROUGHOUT THE WEEK.
We’ve all heard the theories on different study methods and finding the right type for each of us. Some of us are auditory learners, some of us are visual. Recently I’ve experimented with learning through questions. After all, we need to recall the knowledge when prompted by the question.
I’ve made a few questions and answers for you guys to sample and see if it suits you.
For more questions, come visit our Facebook page. WE WILL be regularly uploading new questions throughout the week.
Have you heard of figure1? The app on android and iOS that aims to share images of the diverse range of ailments that afflict humanity? Its been publicised as an Instagram like app for health professionals. It gives an opportunity for health professionals to share interesting cases with other like-minded people around the world. The app offers opportunity for spot diagnosis, discussion of unusual/difficult cases and sharing of ideas regarding treatments. Its particularly targeted to medical students who have not transitioned to the clinical years.
Nevertheless, the app hasn’t been without controversy. There is always concern about the potential for patient identities being revealed. We can also never be certain that patients have actually given consent to have their photos uploaded into the ether and for sharing with a large community. Moreover, for the general public who can also access the app it reveals the gruesome side of medicine. A side that is rarely evident behind the closed curtains of emergency departments, operating theatres and deep insight the labyrinths of hospital wards. It reveals the coping strategies that some doctors utilise to deal with extremely confronting issues of life and death.
An example being a picture of a man with a nail through his hand and a comment post stating “nailed it” reveals that dark humour that can be pervasive within the medical profession.
I’m keen to hear what you guys think about figure1. Do you use it as a study tool to explore different cases? Have you ever felt confronted or had a negative experience? Be sure to leave a comment and share your thoughts.
A short post today, as medical students and future doctors we will hold a special place in society. We will be a point of contact between patients and the healthcare system. A system that flirts with both the public and private sector.
Several months ago I had the opportunity to read Bad Pharma by Dr Ben Goldacre. It was a really eye opening book about the role of the pharmaceutical industry an its influence on the practice of medicine. It is undeniable that without a viable pharmaceutical industry our arsenal of pharmacotherapy will be highly limited. However, the relationship we will have with this industry must be politely cautious and not digress from the path of critical thought. It is very easy to forget this when being dined, swooned and seduced by the industry. Thankfully our human fragility is noted and there are more legislative barriers in place (in Australia) to prevent less than professional relationships with the pharmaceutical industry.
Here is a really great TED talk by Dr Ben Goldacre
“After all these years, I’ve realised I’ve been sympathetic and not empathetic towards my patients!” exclaimed our clinical tutor.
Even before day one of med school, the word empathy is drilled into the applicants. Myself included.
But what does it mean to be empathetic? I know it’s an important quality to a doctor. Everyone tells me that. But how do you be empathetic?
According to our tutor and a dictionary, one has to have suffered the same pain, gone through a similar experience, understand the nature of the pain, to be empathetic to the patient.
Thus, by this definition, he said that he’s only been sympathetic to patients and never empathetic.
I don’t agree. Because from this definition, I’ll never be able to empathise to the majority of my future patients! What are the odds of me catching Parkinson’s, Alzheimer’s, colon cancers, melanomas and GORD in my lifetime? (touch wood)
To me, empathy stems from being able to relate yourself to someone’s suffering. Bringing yourself from your place of comfort and down to the level of the patient’s pain. Not just sitting in the shade as the patient is standing in the rain. Mentally going into the rain and standing with them.
Sympathy on the other hand is seeing other’s suffering, recognising it and saying: “Oh man, you’ve got that rough there!” while thinking thank God that’s not me!
I’d have to admit. Sympathy is a lot easier to practice, and empathy sounds emotionally draining. I don’t think it’d be strategically smart to emotionally empathise with each one of the patients you see. Sometimes even once can drain you dry for the day. This then leads to the question, how do you distance yourself and keep a professional distance while still caring for the patient. I don’t have that answer yet. I’ll leave it for another day to find out.
If you’re a visual/audio person, this video may help to give you a conceptual understanding of the difference between sympathy and empathy.