I would point out that procedures are well known to be performed on the wrong patient — I’ve even read clever blog entries about how to deal with positive findings that have turned up on procedures done on the incorrect patient, and how to finesse the consultation done by the wrong subspecialist (Dr. John Smith in lieu of Dr. Jane Smythe or whatever)– the neurologist’s exam, EEG, and EMG study — painstakingly performed on the woman with the GI bleed.

On my first visit to an orthopedic surgeon whose specialty was shoulder/elbow, I happened to be experiencing a bad day for the causalgia in my right leg. Unable to wear either sock or shoe, the big ugly purple foot was a vision of loveliness. I was there for a bad elbow fracture from the night before, that the ED doctor predicted would require prompt surgery. In other words, the sling and the cast should have been a give away! Instead, there gathered quite a crowd of fastbreaters in white coats, all staring at my leg… Some were even piling up supplies before beginning some shoulder/elbow procedure to ease the pain and save my… foot.

Ridiculous examples, I know, and out of your context. You are, all of you, too intelligent, focused, and humble in the art of your science to fall prey to fatigue, panic, or the actual harm that inevitably results from hubris.

It’s precisely the “Yeah, right, like *I* am going to err in deciding which labia has the Bartholin cyst or screw up the i.v. order for sedation and pain management (so that this annoying broad will shut up and let me drain the sucker). It all should have been handled at her PCP’s office during office hours, not on the 12th hour of my 7th consecutive day of 12-hour shifting. Damn this sinus infection. I can’t breathe. This really chaps my… OOPS! Well, these things can occur bilaterally, right?”

You and most everyone practicing medicine are smart, talented, dedicated, and unlikely to make stupid errors that some idiotic checklist will prevent. But there is a small likelihood — and if forcing you to slow down and think small for a few moments helps diminish that likelihood? I am all for it.

Why not put your furor into tweaking the instrument itself? Is there a more reasonable process for the ED that you could tolerate and perhaps even appreciate?

Thanks for letting me vent in response to your vent!

1. a partial toenail removal for an ingrown nail

2. LN2 treatment of a wart

This ridiculous extension of a good SURGICAL rule is just plain moronic. Yeah, I am really at risk of removing a normal nail rather than the ingrown one, or removing a nail on patient that does NOT have an ingrown nail!

2 years and I retire. Good-bye to this idiocy.

An abscess seems pretty obvious. But things can get chaotic or the communication isn’t happening, and you end up doing the wrong procedure, or the right procedure on the wrong patient. (I’ve had a patient experience with mistaken identity too.)

Go ahead and sneer at the time-out, and then try explaining yourself to the patient and the family and the hospital administrators and the lawyers when you screw up and make a mistake. Think how terrible you’re going to feel because you didn’t double-check. Think what it’s going to be like to see it in the headlines and read all the snarking and second-guessing and doctor-bashing in the online comments. Don’t assume you’re perfect and it’ll never happen to you; the doc who cut out the wrong kidney on a cancer patient probably never thought it would happen to him either.

I’ll have a glass of ClindaChardonnay with you because y’all sound like fun people, but your attitudes about the time-out are, frankly, dangerous for your patients, not to mention your career.

WTF? These “regulations” are irrelevant. Lesson: make sure you check the box, regardless of whether you actually did it or not.