FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2999068045> ?p ?o ?g. }

• W2999068045 endingPage "300" @default.
• W2999068045 startingPage "295" @default.
• W2999068045 abstract "April 29, 2019 Welcome to our Presidential Plenary. It has been an extraordinary honor to serve as Academic Pediatric Association (APA) President this past year. It is also a great privilege to be here today and a pleasure for me to turn the gavel over to the next president, Paul Chung. As I end my year as President, I want to sincerely thank my APA colleagues on the Board of Directors. All of them are very dedicated and talented people who do so much to advance the care of children and to strengthen the APA. I especially thank Sue Bostwick, Immediate Past-President who was such a wonderful mentor and friend to me this year. And many thanks to our Executive Director, Jessica Konrath. Jessica is truly amazing and we are very fortunate to have her and her fantastic team (Beth King, Jennifer Padilla, Holly Tyrrell, and Laura Turner) working for us in the APA. Thank you to my mentors, Steve Ludwig, Gary Fleisher, Rich Ruddy, Fred Henretig, David Cornfeld, and Michael Katz. I have had so many other cherished mentors in my career and I am sorry I do not have time to mention them all. I would also like to thank all the pediatric residents that I have worked with over the years, as they continue to inspire me and keep me young. Of course, I thank my wonderful family: my mother who is no longer with us, and my 101-year-old father who still coaches me from time to time. I thank my sons Eric and Lonn, and my daughter-in-law Aarti, who will give us a gift of our first grandchild in a few months. And most of all, thank you to my incredible wife Andrea, who has supported me, and put up with me, for more than 40 years! I am sure all of you practicing pediatrics know that we have many highs in our careers mixed in with a few lows. We come together at the Pediatric Academic Societies meeting each year to celebrate the joys of treating children. It is of course, extremely rewarding to assist a seriously ill child as he/she recovers, to guide and support a family going through a terrifying crisis, or to help a well-child grow and develop. We all enjoy teaching medical students and residents the skills that we have learned over the years. These are clearly the highs of pediatrics. Today, I want to speak with you more about some of the lows in our field, something not often discussed. It is something all of us do, but no one likes to talk about. I am referring to Medical Errors. It is likely that everyone practicing medicine has made an error at some point in his/her career. Errors are very common. Fortunately, most are minor and do not reach the patient. However, recent studies suggest that medical errors are the third leading cause of death in the United States.1Makary MA Daniel M Medical error—the third leading cause of death in the US.BMJ. 2016; 353: i2139Crossref PubMed Scopus (1703) Google Scholar In one study of internal medicine trainees, 45% reported being involved in a serious medical error.2White AA Gallagher TH Krauss MJ et al.The attitudes and experiences of trainees regarding disclosing medical errors to patients.Acad Med J Assoc Am Med Coll. 2008; 83: 250-256Crossref Scopus (105) Google Scholar In a survey of practicing physicians, 10.5% reported they were involved in a major medical error during the prior 3 months.3Tawfik DS Profit J Morgenthaler TI et al.Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors.Mayo Clin Proc. 2018; 93: 1571-1580Abstract Full Text Full Text PDF PubMed Scopus (274) Google Scholar There are no statistics for academic pediatricians, but it is reasonable to assume we are not much different. Medical errors may be more common than we realize, since many are never reported. It is well known that physicians and nurses struggle with what to say to patients and families after an error.4Selbst SM Difficult duty of disclosing a medical error.Contemp Pediatr. 2003; 20: 51-63Google Scholar,5Bell SK Mann KJ Truog R et al.Should we tell parents when we've made an error?.Pediatrics. 2015; 135: 159-163Crossref PubMed Scopus (11) Google Scholar In 1 older study (1991), Wu surveyed house officers about mistakes they had made and the residents told the attending doctor in only half the cases. They told the family about the error in only 24% of cases.6Wu AW Folkman S McPhee SJ et al.Do house officers learn from their mistakes?.JAMA. 1991; 265: 2089-2094Crossref PubMed Scopus (510) Google Scholar In a more recent study (2008), faculty and residents were surveyed and 73% reported they usually discuss mistakes with colleagues.7Kaldjian LC Forman-Hoffman VL Jones EW et al.Do faculty and resident physicians discuss their medical errors?.J Med Ethics. 2008; 34: 717-722Crossref PubMed Scopus (45) Google Scholar Yet only 49% had ever observed an experienced physician discuss an error with a patient or family. Finally, in an even more recent study (2015), a survey of American Academy of Pediatrics (AAP) members revealed that 98% believed disclosure of a medical error was important.8Kolaitis IN Schinasi DA Ross LF Should medical errors be disclosed to pediatric patients? Pediatricians' attitudes toward error disclosure.Acad Pediatr. 2016; 16: 482-488Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Still, 69% had no formal training to disclose a medical error. We are making progress in admitting and disclosing our mistakes, but we still have room for improvement. How does this happen? Why do we make so many errors in medicine? It is complicated! It is well known that a faulty system often makes some medical errors inevitable. Sometimes we fail to work as a harmonious team, and communication failures lead to errors.9Selbst SM Levine S Mull C et al.Preventing medical errors in pediatric emergency medicine.Pediatr Emerg Care. 2004; 20: 702-709Crossref PubMed Scopus (37) Google Scholar, 10Ruth JL Geskey JM Shaffer ML et al.Evaluating communication between pediatric primary care providers and hospitalists.Clin Pediatr. 2011; 50: 923-928Crossref PubMed Scopus (25) Google Scholar, 11Adamson TE Schann JM Guillan DS et al.Physician communication skills and malpractice claims; a complex relationship.West J Med. 1989; 150: 356-360PubMed Google Scholar Fatigue definitely plays a role. Resident work hours are, of course, restricted and carefully monitored. But many trainees still work 24 hours without rest and work hours for faculty/attending physician are not monitored. One study showed that after you are awake for 24 hours, your psychomotor function is likely similar to someone with a blood alcohol level of 0.1%, above the legal limit in most states.12Dawson D Reid K Fatigue, alcohol and performance impairment.Nature. 1997; 388: 235Crossref PubMed Scopus (764) Google Scholar Furthermore, I am certain that everyone in the audience has practiced in settings of chaos. We are often too busy to give full attention to a patient. Understandably, this can lead to errors.9Selbst SM Levine S Mull C et al.Preventing medical errors in pediatric emergency medicine.Pediatr Emerg Care. 2004; 20: 702-709Crossref PubMed Scopus (37) Google Scholar,13Trziak S Rivers EP Emergency overcrowding in the United States: an emerging threat to patient safety and public health.Emerg Med J. 2003; 20: 402-405Crossref PubMed Scopus (584) Google Scholar And, we are often interrupted during our work. In one study, nurses and physicians were shadowed in a busy emergency department of a Level 1 Trauma Center.14Brixey JJ Tang Z Robinson DJ et al.Interruptions in a level 1 trauma center: a case study.Int J Med Inform. 2008; 77: 235-241Crossref PubMed Scopus (111) Google Scholar That study found that physicians were interrupted 10 times/hour and nurses were interrupted 12 times/hour, by pagers, phone calls, and other coworkers. The staff performed between 1 and 8 other activities before returning to the original task. Despite these circumstances, we must make quick decisions with life-long consequences. The chance for error is high. Of course, medical errors have been well studied in recent years and the etiology is much more complex than what I just described. We have made great progress in reducing medical errors. Hospitals and clinicians all over the country are hyper-focused on patient safety and quality improvement to make patient care more safe and effective. My goal is not to delve deeply into this now. Rather, I want to focus on the impact of these errors. Certainly, after a medical error, the patient is our primary focus. But the clinician also suffers greatly. None of us went to medical school with the idea of harming a patient, particularly a child. When a clinician commits an error that harms a patient, it is likely to be the low point of his/her career. We know that some physicians suffer from burnout and this is closely linked to medical errors. Several studies indicate that burnout leads to medical errors, especially if burnout is severe enough to cause depression.3Tawfik DS Profit J Morgenthaler TI et al.Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors.Mayo Clin Proc. 2018; 93: 1571-1580Abstract Full Text Full Text PDF PubMed Scopus (274) Google Scholar,15Fahrenkoph AM Sectish TC Barger LK et al.Rates of medication errors among depressed and burnt out residents.BMJ. 2008; 336: 488-491Crossref PubMed Scopus (755) Google Scholar The relationship between depression and reported medical errors is actually bidirectional. That is, involvement in a medical error is associated with decreased quality of life, increased burnout, and symptoms of depression.16Shanafelt TD Balch CM Bechamps G et al.Burnout and medical errors among American surgeons.Ann Surg. 2010; 251: 995-1000Crossref PubMed Scopus (1158) Google Scholar, 17West CP Huschka MM Novotny PJ et al.Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.JAMA. 2006; 296: 1071-1078Crossref PubMed Scopus (968) Google Scholar, 18Newman MC The emotional impact of mistakes on family physicians.Arch Fam Med. 1996; 5: 71-75Crossref PubMed Scopus (144) Google Scholar, 19Sen S Kranzler HR Krystal JH et al.A prospective cohort study investigating factors associated with depression during medical internship.Arch Gen Psychiatry. 2010; 67: 557-565Crossref PubMed Scopus (223) Google Scholar Let me tell you about a personal experience. Every year, for the past 15 or so, we organize a symposium on Patient Safety and Medical Errors for the first-year residents in my pediatric residency training program. Our goal is to help residents practice medicine carefully to prevent errors. But another goal is to help them learn how to cope with an error. At this annual symposium, I tell the group about the 3 worst errors I have made in my career. It is somewhat difficult to relive these each year, but important for the residents to see that even their leaders are not perfect. Here is a one encounter that still haunts me.When I was a second year pediatric resident (1979), I evaluated an infant in our outpatient pediatric clinic with persistent vomiting.20Rappaport DI Selbst SM Medical errors and malpractice lawsuits: impact on providers.Pediatr Emerg Care. 2019; 35: 440-442Crossref PubMed Scopus (4) Google Scholar Although the visit took place almost 40 years ago, I clearly remember the details. It was almost 5 pm and the clinic was closing soon. Nursing staff wanted to leave on time and I could feel the “not-so-subtle” pressure to “be efficient” with my last patient of the day. After examining the infant, I told the mother the best thing to do for the vomiting is to discontinue her usual feedings and give the child a balanced electrolyte solution instead. (Ondansetron did not exist back then.) The mother told me, in Spanish, “Doctor, that is what I am doing, but the baby keeps vomiting.” I spoke Spanish, and insisted that the mother should just “keep going” and “he'll be all right.” I instructed her to give the baby small, frequent feedings, just sips of the electrolyte solution each time. The mother insisted she was already doing this, but he continued to vomit. I then instructed her to stop the feedings temporarily. I told her to “wait a few hours to let the stomach rest, then try feeding again.” Reluctantly, the mother took her baby home. The next morning, I arrived at the clinic to find a crowd of doctors and nurses in the small treatment room, working desperately to resuscitate a patient. My patient! A surgeon was attempting to obtain vascular access with a venous cut-down on the infant's lower extremity (intraosseous access was not in vogue at the time). The baby was in shock; the mother was in tears. I felt terrible about my mismanagement of this infant. There was a communication problem, but it was not related to language. It was related to my inability to hear the mother and my lack of understanding about the infant's severity of illness. Of course, I was now worried about the baby, but I was also worried about myself. How could I allow this to happen? Was I in too much of a hurry to give the case sufficient thought? Was my clinical judgment really that poor? What would my fellow residents and my Program Director think of me after they learned of this case?20Rappaport DI Selbst SM Medical errors and malpractice lawsuits: impact on providers.Pediatr Emerg Care. 2019; 35: 440-442Crossref PubMed Scopus (4) Google Scholar Fortunately, the infant recovered and was soon discharged from the hospital. From this experience, I learned the cardinal rule of pediatrics: LISTEN TO THE PARENT. No matter how distracted or preoccupied one is, this remains essential. I also learned to watch for nonverbal cues. I can still remember the look on the mother's face as she left the medical clinic that day. She had the look of a worried mother. It is the face that says: “Doctor there is something wrong with my baby, and I know because I am the mother.” On that day in 1979, I got a glimpse of her face, but I just blew right past it. I was more focused on the face of the clock on the wall. I changed my practice after this event, and I will never discharge an infant from the emergency department unless he/she can demonstrate the ability to take oral fluids without vomiting. I learned to observe patients until they look well, regardless of any external pressures to maintain patient flow. I also realized how fortunate I am to work with wonderful, talented, and supportive colleagues. They have rescued my patients, and me, numerous times. If this infant had a poor outcome, I probably would not be willing to share this story so openly. Who knows if I would still be practicing medicine.20Rappaport DI Selbst SM Medical errors and malpractice lawsuits: impact on providers.Pediatr Emerg Care. 2019; 35: 440-442Crossref PubMed Scopus (4) Google Scholar Perhaps you are aware of a recent case in Great Britain. In 2011, Dr Bawa-Garba, a pediatric trainee, returned to work after an extended leave of absence (she just had a baby).21Cohen D Back to blame: the Bawa-Garba case and the patient safety agenda.BMJ. 2017; 359: j5534Crossref PubMed Scopus (43) Google Scholar She returned to an understaffed hospital with overworked personnel, and the computers were down that evening. I am sure some in this audience have had a similar, inauspicious night during your career. On this shift, her first night back on service, she cared for a 6-year-old boy who died of sepsis. During the course of treatment, the child received a medication that further lowered his blood pressure. The doctor did not specifically order this medication, but failed to make it clear to nurses that it should not be given in the face of hypotension due to his illness. After the child's death, the attending physician, or senior consultant (who knew of the patient but had not seen the child) asked the resident to write her reflections on the case, so she could learn from the experience. The resident did so, and noted that perhaps she could have been more clear with the nurses. She could have given antibiotics sooner; she could have insisted on a stat x-ray among other things. This self-reflection was used against the pediatric trainee. She and 2 nurses involved in the case were charged and convicted of manslaughter in 2015. The doctor received a 2-year suspended jail sentence and she was unable to work for several years. The supervising physician was not charged. The resident doctor's ordeal recently ended, 7 years after the patient's death, when the Court of Appeal in the United Kingdom reinstated her.22Dyer C Hadiza Bawa-Garba can return to practice under close supervision.BMJ. 2019; 365: 1702Crossref Scopus (3) Google Scholar Between 2006 and 2013, 11 doctors in the United Kingdom were charged with medical manslaughter (gross negligence) and 55% were convicted. Since 2014, 4 more physicians in the United Kingdom have been charged with medical manslaughter and are awaiting trial.23White P More doctors charged with manslaughter are being convicted, shows analysis.BMJ. 2015; 351: h4402Crossref PubMed Scopus (7) Google Scholar Fortunately, in the United States, it is extremely rare for a physician to be charged with a crime after a medical error. We have another form of punishment. Malpractice lawsuits! Malpractice lawsuits are an undeniable part of medicine, and they are common. Surveys done by the AAP have shown that one third of pediatricians have been named in a malpractice suit.24Parikh PD Goldsmith J Medical liability experiences of pediatricians.in: Dunn SM McAbee GN Medicolegal Issues in Pediatrics. 7th ed. American Academy of Pediatrics, Evanston, Ill2012: 167-178Google Scholar Pediatric residents are also at risk for malpractice suits as they often care for the most complex patients. In fact, approximately 10% of lawsuits involving pediatricians originated during the physician's training.24Parikh PD Goldsmith J Medical liability experiences of pediatricians.in: Dunn SM McAbee GN Medicolegal Issues in Pediatrics. 7th ed. American Academy of Pediatrics, Evanston, Ill2012: 167-178Google Scholar In reality, anyone who provides medical care to children is at risk for being sued. Experience and proper training may help reduce litigation risk, but no one is immune. Most cases settle out of court and only 10% reach a jury.25Selbst SM Friedman MJ Singh SB Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.Pediatr Emerg Care. 2005; 21: 165-169Crossref PubMed Google Scholar,26Glerum KM Selbst SM Parikh PD et al.Pediatric malpractice claims in the emergency department and urgent care settings from 2001 to 2015.Pediatr Emerg Care. 2018; (doi:) (Epub ahead of print)10.1097/PEC.0000000000001602Crossref PubMed Scopus (12) Google Scholar But the legal process is long and draining. After a child has a bad outcome, a malpractice lawsuit is like adding salt to the wound. When you receive the “Complaint” in the mail that indicates a lawsuit has been filed, it can be devastating. I was involved in such a lawsuit many years ago. A line from the 10-page Complaint in Civil Action read, “Medical treatment rendered by Dr. Selbst…was so negligent and reckless to consist of medical malpractice, which resulted in catastrophic and permanent injuries to the minor plaintiff.”20Rappaport DI Selbst SM Medical errors and malpractice lawsuits: impact on providers.Pediatr Emerg Care. 2019; 35: 440-442Crossref PubMed Scopus (4) Google Scholar It was not true; but it still hurt. Regardless of the legal ramifications, a serious error will torment you. You could easily become the second victim. Dr Albert Wu, a Professor at Johns Hopkins Bloomberg School of Public Health University, described the “second victim” phenomenon several years ago.27Wu AW Medical error: the second victim. The doctor who makes the mistake needs help too.BMJ. 2000; 320: 726-727Crossref PubMed Scopus (824) Google Scholar He noted that physicians who commit medical errors are often traumatized and require significant support, both personally and professionally. There is some recent concern about calling us “victims.” Perhaps there will be a new term someday. Regardless, it is clear that the clinician(s) involved also suffers after an adverse event. Second victims worry about losing their job, their reputation, their medical license, disciplinary action, and a malpractice lawsuit. Wu described several factors that lead to the “second victim” phenomenon, including physicians’ expectation of perfection. “Second victims” often demonstrate both physical and psychosocial symptoms.27Wu AW Medical error: the second victim. The doctor who makes the mistake needs help too.BMJ. 2000; 320: 726-727Crossref PubMed Scopus (824) Google Scholar Many will have fatigue, insomnia, tachycardia, muscle tension, and dyspnea. Many others have psychosocial symptoms including anxiety, sadness, anger, decreased empathy, and even frank depression or thoughts of suicide.28Wu AW Folkman S McPhee SJ et al.How house officers cope with their mistakes.West J Med. 1993; 159: 565-569PubMed Google Scholar A study by Scott et al reported the most common psychosocial and physical symptoms29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar (Tables 1 and 2). Unfortunately, few institutions have processes in place to support these providers.Table 1Second Victim: Common Psychosocial SymptomsFrustration77%Decreased job satisfaction71%Anger68%Extreme sadness68%Difficulty concentrating65%Loss of confidence65%Grief, remorse, depression55%Source: Scott et al.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar Open table in a new tab Table 2Second Victim: Common Physical SymptomsExtreme fatigue52%Sleep disturbance45%Increased heart rate42%Increased BP42%Muscle tension39%Rapid breathing35%Source: Scott et al.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google ScholarBP indicates blood pressure. Open table in a new tab Source: Scott et al.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar Source: Scott et al.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar BP indicates blood pressure. Second victims may have lack of concentration and poor memory after an event, which can last for weeks and may cause significant impairment.30Wu AW Steckelberg RC Medical error, incident investigation and the second victim: doing better but feeling worse?.BMJ Qual Saf. 2012; 21: 267-270Crossref PubMed Scopus (96) Google Scholar This could lead to further errors, including missed diagnoses and unnecessary diagnostic testing and treatment. One recent study of 6700 physicians, noted that 691 were involved in a (self-perceived) major medical error. These physicians were more likely to have symptoms of burnout (78% vs 51%), fatigue (47% vs 31%), and suicidal ideation (13% vs 6%).3Tawfik DS Profit J Morgenthaler TI et al.Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors.Mayo Clin Proc. 2018; 93: 1571-1580Abstract Full Text Full Text PDF PubMed Scopus (274) Google Scholar About 10% to 15% consider leaving the practice of medicine because of a serious adverse event.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar Scott describes a predictable, 6-stage model of the reaction to a medical error,29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar which is somewhat like the stages of grief after a significant loss, described years ago by E. Kubler-Ross (Table 3).Table 3Six Stages of Second Victim RecoveryChaos, accident responseIntrusive reflectionsRestoring personal integrityEnduring the inquisitionObtaining emotional first aidMoving onSource: Scott et al.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar Open table in a new tab Source: Scott et al.29Scott SD Hirschinger LE Cox KR et al.The natural history of recovery for the healthcare provider “second victim” after adverse patient events.Qual Saf Health Care. 2009; 18: 325-330Crossref PubMed Scopus (405) Google Scholar For those named in a malpractice lawsuit, the experience is similar. Few cases result in payment to the plaintiff. Few cases go to court and when a case does end in a courtroom, doctors usually prevail.25Selbst SM Friedman MJ Singh SB Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.Pediatr Emerg Care. 2005; 21: 165-169Crossref PubMed Google Scholar,26Glerum KM Selbst SM Parikh PD et al.Pediatric malpractice claims in the emergency department and urgent care settings from 2001 to 2015.Pediatr Emerg Care. 2018; (doi:) (Epub ahead of print)10.1097/PEC.0000000000001602Crossref PubMed Scopus (12) Google Scholar Regardless of the verdict, the legal process can dominate the provider's professional and personal life for years, even affecting his/her family. A condition described as “Medical Malpractice Stress Syndrome” is common after a lawsuit.31Charles SC Malpractice litigation and its impact on physicians.Curr Psychiatr Ther. 1986; 23: 173-180PubMed Google Scholar Almost all (95%) physicians who are sued have “emotional disequilibrium” and report frustration, anger, and anxiety.32Charles SC Coping with a medical malpractice suit.West J Med. 2001; 174: 55-58Crossref PubMed Scopus (64) Google Scholar,33Charles SC Pyskoty CE Nelson A Physicians on trial-self-reported reactions to malpractice trials.West J Med. 1988; 148: 358-360PubMed Google Scholar Many suffer headaches, abdominal pain, and other gastrointestinal symptoms. About 30% of physicians who have been sued report symptoms of depression, such as insomnia, loss of energy, or feelings of hopelessness.33Charles SC Pyskoty CE Nelson A Physicians on trial-self-reported reactions to malpractice trials.West J Med. 1988; 148: 358-360PubMed Google Scholar They worry about their honor and professional reputation. They feel ashamed, embarrassed, and doubt their skills. They are frequently concerned about their finances and medical license. Being named in a lawsuit may even lead to physician retirement. Fortunately, thoughts of suicide are rare.33Charles SC Pyskoty CE Nelson A Physicians on trial-self-reported reactions to malpractice trials.West J Med. 1988; 148: 358-360PubMed Google Scholar Social isolation or self-medication can be serious “side effects” of a lawsuit. Somehow, we must accept that a lawsuit is part of the business of medicine. Most physicians can learn from the experience; and some will change their practice as a result. In coping with the stress of a medical error, the provider needs support. Unfortunately, most of us have received little training in managing a medical error acutely, or in self-care thereafter.2White AA Gallagher TH Krauss MJ et al.The attitudes and experiences of trainees regarding disclosing medical errors to patients.Acad Med J Assoc Am Med Coll. 2008; 83: 250-256Crossref Scopus (105) Google Scholar First, the clinician should recognize that a medical error is usually multifactorial and many errors relate to the “system.” This was obvious in the case of the trainee in the United Kingdom, described above. This does not excuse the clinician entirely, and I remind my residents frequently, “You are part of the system and you have a responsibility to be careful.” Still doctors and nurses are often “set up” to make a mistake and should be aware of this. Likewise, being named in a malpractice lawsuit does not mean you are a “bad doctor.” In fact, the clinician may not have done anything wrong. In 12% to 18% of lawsuits there is no medical error.25Selbst SM Friedman MJ Singh SB Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.Pediatr Emerg Care. 2005; 21: 165-169Crossref PubMed Google Scholar,26Glerum KM Selbst SM Parikh PD et al.Pediatric malpractice claims in the emergency department and urgent care settings from 2001 to 2015.Pediatr Emerg Care. 2018; (doi:) (Epub ahead of print)10.1097/PEC.0000000000001602Crossref PubMed Scopus (12) Google Scholar Next, the clinician involved in an error should disclose the error and apologize to the family when indicated. Although error disclosure can be very stressful, patients and parents are incredibly forgiving when there is an apology. The apology will not necessarily lead to a lawsuit and in fact may reduce the likelihood of litigation. Furthermore, there is some evidence that the clinician wi" @default.
• W2999068045 created "2020-01-23" @default.
• W2999068045 creator A5072205012 @default.
• W2999068045 date "2020-04-01" @default.
• W2999068045 modified "2023-10-16" @default.
• W2999068045 title "The Highs and Lows of Pediatrics: May the Academic Pediatric Association Be With You" @default.
• W2999068045 cites W1612190403 @default.
• W2999068045 cites W1636736913 @default.
• W2999068045 cites W1963836012 @default.
• W2999068045 cites W1965751135 @default.
• W2999068045 cites W1985008695 @default.
• W2999068045 cites W1985322877 @default.
• W2999068045 cites W2003015733 @default.
• W2999068045 cites W2003202103 @default.
• W2999068045 cites W2040266943 @default.
• W2999068045 cites W2053682921 @default.
• W2999068045 cites W2062054568 @default.
• W2999068045 cites W2063172343 @default.
• W2999068045 cites W2080542372 @default.
• W2999068045 cites W2110777766 @default.
• W2999068045 cites W2111128742 @default.
• W2999068045 cites W2115385268 @default.
• W2999068045 cites W2119331287 @default.
• W2999068045 cites W2133442364 @default.
• W2999068045 cites W2141392501 @default.
• W2999068045 cites W2144447924 @default.
• W2999068045 cites W2150756606 @default.
• W2999068045 cites W2172158728 @default.
• W2999068045 cites W2215241070 @default.
• W2999068045 cites W2346834216 @default.
• W2999068045 cites W2768532590 @default.
• W2999068045 cites W2790071316 @default.
• W2999068045 cites W2857887762 @default.
• W2999068045 cites W2893412376 @default.
• W2999068045 cites W2898069583 @default.
• W2999068045 cites W2937653217 @default.
• W2999068045 cites W2946402582 @default.
• W2999068045 cites W2949222651 @default.
• W2999068045 cites W73815476 @default.
• W2999068045 doi "https://doi.org/10.1016/j.acap.2020.01.003" @default.
• W2999068045 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/31931185" @default.
• W2999068045 hasPublicationYear "2020" @default.
• W2999068045 type Work @default.
• W2999068045 sameAs 2999068045 @default.
• W2999068045 citedByCount "2" @default.
• W2999068045 countsByYear W29990680452023 @default.
• W2999068045 crossrefType "journal-article" @default.
• W2999068045 hasAuthorship W2999068045A5072205012 @default.
• W2999068045 hasConcept C142853389 @default.
• W2999068045 hasConcept C15744967 @default.
• W2999068045 hasConcept C187212893 @default.
• W2999068045 hasConcept C542102704 @default.
• W2999068045 hasConcept C71924100 @default.
• W2999068045 hasConceptScore W2999068045C142853389 @default.
• W2999068045 hasConceptScore W2999068045C15744967 @default.
• W2999068045 hasConceptScore W2999068045C187212893 @default.
• W2999068045 hasConceptScore W2999068045C542102704 @default.
• W2999068045 hasConceptScore W2999068045C71924100 @default.
• W2999068045 hasIssue "3" @default.
• W2999068045 hasLocation W29990680451 @default.
• W2999068045 hasOpenAccess W2999068045 @default.
• W2999068045 hasPrimaryLocation W29990680451 @default.
• W2999068045 hasRelatedWork W1506200166 @default.
• W2999068045 hasRelatedWork W1995515455 @default.
• W2999068045 hasRelatedWork W2039318446 @default.
• W2999068045 hasRelatedWork W2048182022 @default.
• W2999068045 hasRelatedWork W2080531066 @default.
• W2999068045 hasRelatedWork W2748952813 @default.
• W2999068045 hasRelatedWork W2899084033 @default.
• W2999068045 hasRelatedWork W3031052312 @default.
• W2999068045 hasRelatedWork W3032375762 @default.
• W2999068045 hasRelatedWork W3108674512 @default.
• W2999068045 hasVolume "20" @default.
• W2999068045 isParatext "false" @default.
• W2999068045 isRetracted "false" @default.
• W2999068045 magId "2999068045" @default.
• W2999068045 workType "article" @default.