Doctor's duty of care

Debby - posted on 04/20/2011

No, it is in no way acceptable....and it MUST be reported to your state's governing board! Suing drives up costs and doesn't red flag behavior.
1) The nurse likely prep-ed the vaccination.
2) Same or other nurse should have delivered it to the room and checked it.
3) Doc should have checked it before inoculation.
Folks, I know what I speak of--I have been married to a medical professional ( and we've paid malpractice insurance) for years!
We are all human, yes, but just like the driver who chooses to drink and drive, WE ARE ACCOUNTABLE!

Kari - posted on 04/19/2011

I would definitely think the authorities should be contacted! It is true that everyone is human and makes mistakes, but who knows if this is really the first time that he has made this "mistake". I would definitely want someone to investigate how the doctor was able to make such and error.

Veronique - posted on 04/19/2011

Yes i would be furious, but really if there was not adverse effects on the child and the child is happy and healthy then you know what Doctor are humans and humans make mistakes. I wouldn't push the issue farther, he admitted he made a mistake and he apoligize for it so lets not make a federal case out if this.

Tah - posted on 04/18/2011

Ok....

Brittany - posted on 04/18/2011

Well, since you nor I are the doctor we can only speculate on what his intentions were. I hope he had nothing but the best of intentions but another part of the human condition is not always having pure intentions.
An apology and it being reported to the appropriate authorities for that state is definitely the extent I would take it, with no harm being done I don't think it's right to sue him or anything, that's taking it too far. He's an adult, and part of being an adult is accountability, admitting when you're wrong and accepting the consequences.

Tah - posted on 04/18/2011

yeah, when i was a medical assistant, i saw some, but not as much i see now, it does happen less in the office setting than in the hospital but it happens all the same. Once you become a licensed professional though it is a whole new ball game and we dont take it lightly one bit. i advocate for my patients in ways they and their family members dont even know. I have to correct tired doctors that have been on call to many different facilites all the time when they arent thinking clearly and give a order that may harm the patient, i have to be the one to say, dont you mean give the patient potassium, not kayexalate for this lab. Or i left you 3 notes in the MD book about this and you haven't responded but the patient isnt doing any better. Its a delicate balance and we understand that, but as much as we try to avoid it, there are days that mistakes happen and an apology when no harm is done should be enough. I see you said o he was trying to save his own skin...or he could have honestly felt bad and wanted to correct it.

Brittany - posted on 04/18/2011

I was a certified medical assistant and I have recently ceased working to go back to school. I have decided to become a pharmacy technician in the hospital setting. Or a chemotherapy pharmacy technician, haven't quite decided.

He could have admitted it because he took it seriously, that can't be ruled out, or he could've realized the mistake would've been caught possibly by somebody else and he was trying to save his own skin.

Tah - posted on 04/18/2011

what do you do again??, im just asking. also i dont want to make it seem as if the mistake was okay, because it isn't, but they do happen and I think that the fact that he admitted it and apologized says alot about the fact that he did treat it as a serious matter

Brittany - posted on 04/18/2011

Honestly, no, I have never seen anybody make such a mistake like that. Luckily, the child in this case wasn't injured, that's definitely the first thing on the list of priorities, but the second thing that's important is it being reported to the appropriate parties to ensure it doesn't ever happen again because the next child it happens to, if it does ever happen again, might not be so lucky.
Making a mistake is a part of the human condition, I do agree mistakes happen, but you need to be careful when it comes to things that could seriously injure or kill somebody, mixing up vaccinations could kill a child or cause irreversible damage. It's a very serious matter and should be treated as such.

Tah - posted on 04/18/2011

so as a licensed professional, you have never made a mistake or worked with someone who made a honest mistake for any number of reasons???

Brittany - posted on 04/18/2011

I wasn't saying that he should be punished, but if I was that mother I would definitely look for a new doctor, and I do work in the healthcare field so I do know what goes on. When you hold other peoples' lives in your hands you can never be too careful.



Yes, nothing happened THIS time, but something could've gone wrong, it's the doctor's job to make sure it doesn't happen.

Tah - posted on 04/18/2011

so we need to be perfect..got it....its like beating a dead horse because unless you work in it, as a physician or other licensed health professional youwont truly understand what goes on while you are doing all your checking and trying to live up to the impossible standards imposed on you. Bottom line is, the child was NOT injured, the doctor ADMITTED and APOLOGIZED and imo it was a honest mistake that anyone could have made and it doesnt need to go any further.

Brittany - posted on 04/18/2011

Yes, doctors are human, they do make mistakes. HOWEVER, they are a trained, licensed professionals, they should be checking, double checking, and triple checking themselves and their staff. Mistakes when it comes to the life and health of your child are simply unacceptable, bottom line.

Cathy - posted on 04/18/2011

This happened to my son!

When I took him for his preschool booster, he was given the adult booster vaccination by mistake. The vaccination was given by one of the practice nurses, which is normal here. Had it in the morning, sent my son off to school in the afternoon. While he was at school I had a phone call from my doctor (head of the practice) telling me the mistake. I had a full apology plus told to bring my son in straight away should he show any signs of reaction and we'd be seen immediately. My son was fine for the rest of the day but the following day he was burning up, no energy so we went straight to the doctors. He got a thorough check up and a prescription for pain relief to help with his temperature. He was fine again by the afternoon.

Was I angry? Sure. But mistakes happen. I was pleased they contacted me and told me the truth. It's made me much more aware to have them double check that they are giving the right dose in future. I'm sure they also had to look at adjust protocols within the practice or atleast rearranging the vaccines so the two couldn't so easily be confused.

No, I didn't feel the need to report it any further.

Erin - posted on 04/17/2011

I actually agree with Jane. The fact this doctor caught his mistake quickly, and apologised, says a lot to his character and ethics. Plenty of doctors would not mention it (for the liability reasons Mary mentioned) or simply brush it off if someone else noticed. The acknowledgement of his error and apology shows remorse, and I would be happy with an assurance that their protocols would be reviewed so this didn't happen again.

As I said in my PP, I'm a Medical Secretary in a large General Practice. The clinical staff have regular meetings. They attend regular training days and seminars in order to keep their licence and accreditation. We are also audited every two years to ensure our policies and procedures meet professional standards. If a mistake like this happened at my surgery, those doctors would be in a meeting that night. They would act immediately to see where the error happened. There is no way it would not be dealt with within the practice, if only for the fact that they must have all these things in order to pass accreditation.

Amber - posted on 04/17/2011

Yes, I agree with you. They are free to, but are not required to. If you continue to deal with them then they should discuss it with you. But I think it would be more of a policy disclosure than one of any discipline.

Jane - posted on 04/17/2011

But supposing you DON'T stop dealing with the doctor and act like an adult and discuss this. The doctor is free to discuss it with you. That is what was under discussion.

Amber - posted on 04/17/2011

A change to the system would be a procedural change, which I said is disclosable. It is not discipline.
Doctors are not always the ones that you report the problem to. They are usually part of a larger entity, such as a physcians' group, hospital, medical board, or practice. Problems would be reported to these entities and not necessarily the doctor themselves.

Of course an employee can discuss themselves, but you usually do not report a person to themselves. That was the point I was attempting to make.

Jane - posted on 04/17/2011

In the case of the doctor making the error, he/she can choose to disclose what will be done in general terms. He doesn't have to blame a particular employee or discuss particulars, but he can explain how the system will be audited and changed so that it never happens again.

In any case, the doctor IS apparently the one who committed the error, or at least is taking responsibility for it, and the doctor can discuss whatever he wants about himself.

Amber - posted on 04/17/2011

I just want to point out that it is against confidentiality proceedures in just about every company to disclose any discipline of an employee with any person other than that employee. The hospital/doctors office cannot just disclose write-ups or disciplinary actions to people; they are a business just like any other. They can't disclose private, priviledged information just because somebody asks for it.

So, demanding to see what was done will not happen unless it is a procedural change, which is allowed to be public knowledge.

Kate CP - posted on 04/17/2011

I *love* my GP (who also happens to be our ped). He's seen three generations of my family and is an *awesome* doctor. I've known him just about all my life and I trust him completely with my life and the lives of my children and family (as I have had to do several times). He has literally saved my life several times.

I still don't take his word as gospel. He told me that for my jaundiced 3 day old son that I should give him an ounce of water while I was nursing him (when I was switching sides) to help his liver flush out the toxins. I didn't do it because I didn't think giving a newborn baby water was a good idea (especially since breast milk is mainly WATER). My son recovered from the jaundice just fine without any medical intervention.

He looked at me like I was insane when I told him I was treating my daughter's pinkeye with breast milk and gave me an RX for "in case it stops working". It didn't stop working and I used breast milk to treat my son's pink eye that he got over in just ONE DAY because I treated it with breast milk.

He's made mistakes before, too. I went to see him for acute abdominal pain and he thought it was really bad reflux. Turns out I had gallstones. But I still go see him...I trust him.

Mary - posted on 04/17/2011

Nikki, nowhere did I even remotely suggest that people shouldn't ask questions of their doctor, or speak out when something isn't right. I firmly believe that all patients have not only a right, but a responsibility to be an active participant in their care and treatment.

However, in the case you bring up in the OP, I don't know think it needs to go any further. First off, it sounds as if the doc in question both informed the mother of his error and apologized. It's not like the doc blew it off or denied accountability. Secondly, the child has not suffered any repercussions.

In most cases like this, offices and/or hospitals actually do review the incident, and implement changes to prevent a recurrence. We (as patients) just don't know all the details.
Most businesses are not in the habit of publicizing all of their educational and training inservices or changes in internal policies and procedures.

Jane - posted on 04/17/2011

That means that the doctor in this case, who did apologize, should be commended and not penalized.

And no, we should NOT simply accept what doctors say, but educate ourselves so we can ask any questions that we need to ask in order to understand what is going on. If your doctor won't let you ask questions or either refuses to answer them or brushes off your concerns, it is time to find a new doctor.

Nikki - posted on 04/17/2011

But Mary that doesn't make it ok. So we just continue to not ask questions to take our doctors word as gospel because if we don't they will be dishonest for fear of loosing their job. Yes mistakes in the workplace can at times be dealt with harshly but these rules are there to protect people. Nobody is perfect, everybody makes mistakes but it's how we deal with them that shows our professionalism and continuous dedication to professional development.

Mary - posted on 04/17/2011

Jane, you know the sad truth behind why many doctors won't apologize is that they have been cautioned against doing so by their malpractice carriers. Apologies are viewed as an admission of guilt or wrongdoing, and open them up for potential litigation. It's a sad reflection on our society that doctors are pretty much trained against apologizing for fear of planting the seed of lawsuit in a patient or family's head.

Jane - posted on 04/17/2011

As someone who has had extensive contact with the medical world as the advocate for my husband, my mother and my son, I can tell you the fact that the doctor apologized to you means a huge amount. Do you know how seldom doctors apologize? Some doctors really do believe they are better than their patients and some worry that they aren't and so hide any faults. As a result, doctors don't apologize. If nothing happens as a result of the error, many patients never know. The doctor might be disciplined or the system may be reviewed, but the doctor preserves his "god" status in front of the patient.



If this is the only error this doctor has committed, then it tells me he/she is an honest guy and thus a doctor you can talk to. Those are few and far between and I would stick with him. You also know that from now on this doctor will be especially careful with your family because of this error, and will never make the same mistake again with anyone.



And if you question whether any action is taken, ask! Ask the doctor what he/she plans to do to prevent this from happening again.



I agree with Mary N. - a mom should be a grownup and take the apology in the spirit in which it was given. I would hope she could continue on with this doctor, but if she is going to carry a load of anger, then a switch in doctors is the best idea.

Mary - posted on 04/17/2011

Nikki, they've actually studied this issue extensively in hospitals, and the truth is, people are less likely to report an error if they fear punitive measures, especially the loss of their jobs (this is true in all professions, not just healthcare).



Like Tah, I can see this from both sides. As a mother, I would be beside myself if Molly was accidentally given a wrong vaccine or med....BUT....I know her ped personally and professionally. I know what a truly caring, competent, and hard working guy he is. I also know that he is not infallible. It is entirely possible, that after a night where his pager went off 10 times because other mothers were calling him about their sick child, and he has an office crammed full of sick kids and routine check-ups, his son had a melt down when he dropped him off at school, and his office manager just ran out the door for a family emergency, he may very well make a mistake when seeing my child.



I hope, that despite my upset, I would be decent enough to see that this error was not intentional. I hope that I would be gracious enough to accept his apology, especially if there were no adverse effects to her as a result of the error. I hope that I would not turn into some vindictive bitch hell bent on crucifying someone who had no intentions of harming my child (and, in actuality, did not).



People go on and on about how serious a doctor or nurse's responsibilities are, and about how mistakes are "unacceptable" or should not be tolerated. Really??



Parenting is just as serious a responsibility....any of you ever make an honest mistake? Ever put your kid in a car seat and forget to completely buckle it? Ever give them milk that was a little sour? Ever used eggs or mayo, or anything, only to realize it was past that "best by" date? Ever shifted your eyes and attention off of your kid to order food, and looked down to see your three year old eating a fry he found on the floor? These are all common "mishaps" that happen to parents across the world, and do have the potential to cause harm. Who's going to report you?

Nikki - posted on 04/17/2011

I wasn't suggesting that lack of ethics was responsible for the mistake. I was referring to your comment that if Doctor's are reported for a mistake they are less likely to admit to the next one.

Tah - posted on 04/17/2011

we cant jump from making a seemingly honest mistake to them having no ethics. I know a doctor that will deny anything the nurse ask for her patient if you catch her on the wrong day or time and personally i think she is bi-polar, which only hurts the patient, when she goes in to see patients, they and their family said they could go the rest of their lives without seeing her again because she has no beside manner and in some cases, i think no ethics, our facility has gotten rid of her and gotten a new practice because of these reasons....but an honest mistake of giving the wrong medication, dose, etc...that doesn't equal no ethics in the least bit. I even said, i would address it, and whose to say they haven't received constructive criticism, by all means tell them how you feel and ask for what methods they are using to prevent it from happening again, to your child, or someone elses, but reporting them is something different than that, esp when no harm has come to the baby. it was an honest mistake. Many doctors are in the hospital making rounds late into the evening, and then again in the morning before they even come in to their practice, you never know what the circumstances are and it just sounds like an honest mistake to me......

Tah - posted on 04/17/2011

it is a delicate relationship Kate, i agree with that. If you dont trust them, then by all means, dont return. I just know that there are no doctors that haven't made mistakes, and for the most part, they learn from them and there is almost always action taken, even if the patient isn't privy to it. so i just wouldn't blow something like this out of proportion, o he would know i was upset, and i may even ask what steps they are taking to prevent it, if they said "nothing, it's no big deal,"..then of course they need to be reported because they can't be trusted to handle it within their own practice, but if they said "we have gotten rid of all the expired vaccines and we are having an inservice to be sure staff is aware of the 5 rights,"etc, then i would probably leave it at that.

Nikki - posted on 04/17/2011

But Tah sometimes nothing does happen. If they can't handle constructive feedback and have no ethics then maybe they shouldn't be doctors.

Kate CP - posted on 04/17/2011

I just wouldn't return because I've lost trust with that doctor. If I can't trust my doctor then I won't see him or her any more. It's such a delicate relationship.

Tah - posted on 04/17/2011

I just think people are going on the assumption that nothing happened to the doctor, or that things weren't reviewed. The fact that they caught the mistake and he admitted it lets me know that action was taken in some form or fashion, but i guess because the doctor didnt say well, i was written up, or we are having inservices every monday for the next month on the 5 rights, people assume that if they dont get the medical professional in more trouble by reporting them then nothing will happen, before you report, you can just say something along the lines of.."this makes me very upset and uncomfortable because somethng much worse could have happened, so what assurances do i have that this wont happen again?" because even going to another doctor doesn't assure no mistakes will happen....it will probably mean, next time a mistake happens, they will keep their mouths shut about it instead of being honest and up front, which im sure was no easy task knowing the society we live in today.

Casey - posted on 04/17/2011

I can definately see your point Nikki and I guess it does make sense to report it so it doesn't happen again, I think I am to soft though I hate confronting people but I do think you have a good point.

Nikki - posted on 04/17/2011

I see what your saying Tah, just saying that wouldn't be good enough for me. I would want proof that pro active action is being taken to prevent such a thing happening again.



The other thing I don't think the over used statement that "doctor's are no super hero's" is the point. Of course they are not super hero's but they have to be accountable for their mistakes like the rest of society.



It amuses me that so many of you say that you would just accept the apology but you wouldn't return to that doctor? If the practices are not improved and there is a risk of this happening to another child are you really doing the right thing by not speaking up? No your not, how would you feel if six months later the same thing happened but the child died? Don't we all have a responsibility to speak up if something is not right? If your not going back to the doctor you are acknowledging that they did something wrong, don't just leave it and risk that on somebody else's child.

Casey - posted on 04/17/2011

Yeah I would be pretty unhappy at the doctor for this but I do agree that doctors are only human and mistakes do happen they arn't perfect, I don't think blowing it out of proportion would make any difference it's not going to change what happened and I am sure the doctor would have been very sorry for what had happened so what else would you want from them???
So long as their was no bad side effects to the baby I think I would have just gotten over it but I probably would not be seeing that doctor again.

Tah - posted on 04/17/2011

if there is a doctor or nurse that hasnt made a mistake,i dont know them. When these mistakes are made, even if they dont say anything to you about it, policies and procedures are reviewed and if necessary actions taken. If a nurse gives the worng meds, or wrong dose, just because she (or the doctor) isnt taken out and flogged in front of the patient, doesn't mean that nothing has happened. A warning, write-up, an inservice etc. I guess reading through this post it comes off like some of you think that mistakes are forbidden, and that nothing happens when they do so you have to run and report it, and that isn't the case. The doctor came and apologized and no harm was done, im sure somethings went down behind the scenes, and it wasn't just an "o well"...I dont want to discount the feelings of a mother, because of course i am that also, but sometimes the unfair judgement of the medical professionals just kinda sucks..

Kate CP - posted on 04/17/2011

On another note, I think I would DEFINITELY find a new doctor.

Kate CP - posted on 04/17/2011

I honestly don't know how I would react...I mean, I've had that happen to me with my dogs (and when I was a vet tech I accidentally did it to a dog) and all the animals were fine. I received an apology when it happened to me and I apologized profusely when I did it myself and everything was okay...but a dog is obviously different from a child.

I don't know how I would respond if my doctor made an error like that. Even if it didn't result in any injury...I would be hurt and angry and scared, I know that much. But I don't know what I would do.

Nikki - posted on 04/17/2011

Can I just be clear, I never suggested suing the doctor in my OP.

I was simply saying that I don't think it's acceptable to be content with just an apology. It is a serious mistake even if no harm came to the child. I think in this situation the responsible thing to do would be to file a complaint to ensure the doctor is well aware of the mistake. And to ensure policies and practices are put under review to prevent this from happening again.

So sorry about your husband Jane xx

Tah - posted on 04/17/2011

you are right Jane, and i am very sorry to hear that.

Jane - posted on 04/17/2011

The best way to teach doctors to hide all mistakes, even minor ones, is to sue over everything. At least this doctor apologized. The doctor that killed my husband has never said a word, not even "Sorry for your loss." I would say make sure the doctor knows never to do it again, and save the lawyers for real damage, especially that done with malice.



In addition, it is your child so stick your nose in. Since the doc made the mistake with a vaccination, insist on seeing all the labels of the meds going into your child from now on. Medicine is a giant system - be pro-active to prevent the inevitable screw ups.

Ashley=) - posted on 04/17/2011

Report, report and report.It helps other parents and it also helps the doctor who made the mistake to understand and try his best to never have this happen again.Were all human but when lives are put at risk its serious.

Tah - posted on 04/17/2011

I guess as a mom and nurse who has worked in xray, drs.offices, OTC, rehab, med surg, cardiology etc. I have a different take. You ladies have the view of a mom, you don't see the behind the scenes. We say doctors/nurses are only human but we expect superhuman things from them and goodness forbid they make a mistake, report and sue, report and sue, even if no harm has come from it. Now, when I give injections, I don't bring the vial in because we have a medication room, when I'm on the floor that's where I mix the meds, draw them up etc, I do however have to record the date of expiration, the vaccine, the lot number and where I gave it, left arm, left leg etc.so it's not like we just rush In with syringe full of who knows what wanting to do some harm. However if a family member wants to see the vial, that's fine as well, I'll definitely go back and get it. Again, it depends on protocol and policy and procedure of that facility. Hospitals expect doctors who work for hours and hours at a time to function at peak performance on hour 30 and it's not gonna happen, mistakes do happen. When I am at my post-surgical rehab job, here is what happens within 5 minutes.

Tah-ms. So and so is in pain..
Tah-mr so and so is having a seziure
Tah-the doctor that you paged 2 hours ago is on the phone...o never mind, you were dealing with the seizure so he hung up, you have to repage him...
Tah- pharmacy is on the phone about the medication you reordered, you need a new script(which is why I paged the doctor)
Tah-ms. So and so has a temp of 104.3 and some uggglyyy drainage on her dressing....

And please don't let me add in how much the therapy department stalks me..did I mention I'm in the middle of giving medications when this happens. This is no exaggeration and a rather light day. It's also a breeding ground for errors to happen, which is why we have those proceduresin place and why sometimes they don't work. There are lots of other factors, is it a new nurse/doctor etc. I have orientees all the time and when they are with me I encourage them to ask questions all the time and to prioritize, use your five rights etc. One job I had didn't put armbands on their residents and finding a nurse with enough time on her hands to point each patient out to you was a challenge in and of itself. We do have a job with peoples lives in our hands, and it does require us to try and stay as close to inhuman as possible, but, sometimes circumstances led to errors.

Now, somethings are just plain and simple negligence, but not as much as the public would think. There are things in place that again, people don't know about. Every hospital, facility etc has education officers who do inservice and classes and make sure employees are caught up on up to date information. Whether it's online or you have to come In and take it, there is almost always a test at the end. If you make a medication error, there are write-ups, and more training, if it's a continual thing, you are reported to the stat by your facility in some cases. Some people have to go before the board and have a hearing, but that is in extreme cases. The mom in me of course wants the best for my kids, a doctor/nurse who doesn't make mistakes, but the realist/human in me knows that's not possible, so I can just advocate the best I can for them and be aware.

Amber - posted on 04/17/2011

Giving out 100 vacinations is a completely different story. That was one of my initial questions concerning if it was a first time occurance.

To give out 100 incorrect vacinations is a lack of due diligence, which would be unacceptable in any profession, not just medicine.

I believe a one time occurance should be dealt with within the office so that they can figure out what happened, but with no harm shouldn't go further. Repeated mistakes are unacceptable and should be dealt with in a more thorough matter from a higher authority with a swift punishment.

The two things are in no way the same thing, IMO.

Tracey - posted on 04/17/2011

We had a case locally where a nurse gave the MMR to nearly 100 children that was 8 months out of date. The medical centre's response was that no harm will have come to the children but the parents had to take them back for another jab, not even an apology, just get over it and come back for another one.
Sorry but if a nurse gives that many vaccines without checking the bottle I wouldn't feel safe if she did anything to my child ever again.

Stifler's - posted on 04/17/2011

Back in the day when my brother got vaccinations they came in a vial and the doctor sucked it up with the needle. The ones Logan has been given were filled before I got there or come prefilled I'm not sure. But I can see the nurse mentally checking when she's telling me which one she's giving him and what it's for and what side effects there might possibly be.

Jocelyn - posted on 04/17/2011

Really the needles come in pre-filled?!
That just seems like asking for trouble :S
Our nurses point out everything, even the expiry date; maybe it's a local thing?

Sarah - posted on 04/17/2011

I would imagine that some sort of record would have to be made about what happened, most accidents are recorded in any workplace.....not just to get employees in trouble, but to try and take measures to prevent it happening again.

If it was me, I would expect them to sort out their procedures to ensure nothing similar happened again, I would ask to see proof of that, then I'd accept the apology and move on.

Johanna - posted on 04/16/2011

I too have never seen the label for any of my daughter's vaccinations. They just bring the needles in prefilled. I had a sort of similar experience recently. My daughter had to get an xray of her back. They accidentally took an xray of her legs. They just came in and said; oops sorry we need to do the right one now. I was really upset b/c I didn't want her to have unnecessary radiation. I know it's a small amount and she'll probable be fine but still. I even asked when they were doing it b/c it looked like they were doing her legs and the technician called over to double check. Someone in the dr office told her to go ahead and it was wrong. We did end up going ahead and I accepted "sorry" but it DID make me very upset. But what good is taking it further going to do- it can't be undone. Now if there were negative consequences that's a different story. I know an xray isn't as scary as a vaccine but still...