Medical Error Averted

Cheryl Clark, May 29, 2014

A number of small gaffes by healthcare providers, clinical staff, and the shortcomings of their tools can lead to a single serious or life-threatening medical error. Or they can serve as warnings that enable us to avert catastrophe.

Here's one way a medical error might happen. I know, because two weeks ago, one almost happened to me.

I emphasize almost.

After the mistake was averted, I retraced the excellent care I received in every other respect. Providers were professional, friendly, respectful, and even sympathetic to my health concern over what was ultimately a false alarm.

Maybe I was acting too much like the prima donna, expecting that even a minor episode of care should run perfectly when the patient is me, senior quality editor for HealthLeaders Media who writes about processes of care all the time. La de dah.

But here's the thing: Think about the potential consequences.

The averted error, had it come to pass, could have resulted in a serious mistake, a misdiagnosis, possible treatment with medications freighted with high risk side-effects, and the potential for invasive procedures such as catheterization or surgery.

Let me explain what happened two weeks ago.

During the fires and extremely high temperatures in Southern California earlier this month, I was hunkered over my computer monitor for a long stretch of non-air conditioned hours, sitting, standing and leaning against a chair.


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