Doctors Share The One Mistake That Changed Their Careers.
"We are products of our past, but we don't have to be prisoners of it." - Rick Warren
Doctors of reddit were asked about the biggest mistakes of their medical careers. These are some of their best answers.
As a very young doctor in training I misdiagnosed a woman with epilepsy. Some years prior she had sustained a gunshot wound to the frontal area, damaging the underside of one of her frontal lobes and severing an optic nerve to one of her eyes, as well as some of the muscles that rotated that eyeball. Surgery saved her life but the frontal lobe was scarred and the eye was blinded and always pointed down and at an angle away from her nose.
A few years after that she began having spells of a bizarre sensation, altered awareness, a pounding in the chest, and she had to sit down, stop what she was doing, and couldn't speak. These were odd spells and I assumed she had developed frontal lobe epilepsy from the scar on her brain. Increasing doses of anti-seizure drugs seemed to work initially, but then the spells came back.
A couple years after my diagnosis her endocrinologist, who treated her for diabetes mellitus, checked a thyroid. It was super-high. The spells were manifestations of hyperthyroidism. She drank the radioactive iodine cocktail which ablated her thyroid, got on thyroid replacement therapy, and felt well thereafter. No permanent harm done and she was able to come off the anti epilepsy drugs.
She was obese - not the typical skinny hyperthyroid patient - and if she developed thyroid eye disease, I couldn't tell because her one eye was already so messed up. I see how I screwed it up. but in retrospect I have never been sure what I could have done differently, except test her thyroid at the outset of treatment. Hence, a lot of patients - thousands - have had their thyroid checked by me since then. Every so often I pick up an abnormality and it gets treated.
The lady was an employee of the hospital where I trained and I ran into her one day; she gave me a hug and let me know how this had all gone down. She made a point of wanting me to know she didn't blame me "because I always seemed to care about her and what happened to her."
I think about her, and how I screwed up her diagnosis and set back her care, almost every day. I am a much better diagnostician now but I always remember this case and it reminds me not to get cocky or be too sure that my working diagnosis is correct.
Pathologist here. Biggest mistake I ever made was cutting myself during an autopsy on an HIV patient. Lucky for me, I did not acquire the virus, so everything had a happy ending. (For me, anyway. That guy was still dead.)
Registered nurse here: I was taking care of a man with liver failure who was not a candidate for a transplant. He "waxed and waned" meaning he vacillated between complete brain function and confusion. I brought him his pills and made some small talk. We chatted a little bit before I handed him a cup to drink from on his bedside table. He tossed the pills in his mouth and took a gulp from the cup. He looked at me and said "that's piss" in a really matter of fact way. I checked the cup. It was. While he was confused he must have gone in the cup instead of his urinal and then forgotten about it. Now I always check before handing people cups from their bedside tables.
My mom just retired as an ob/gyn and she told me about a time early on in her career when, while not a real medical mistake, she still almost ruined the operation. She was performing a c-section I think, and she dropped her scalpel on the floor. Before she could think, she blurted out "oh crap" as a reaction. The mother, thinking something was wrong with the baby, started panicking. It took a team of nurses, the husband, and the mother of the patient to calm her down.
I'm a nurse, but I was working in the ER when a guy came in for a scratch on his neck and "feeling drowsy". We start the usual workups and this dude's blood pressure TANKED. We scrambled, but he was dead within 10 minutes of walking through the door. Turns out the "scratch" was an exit wound of a .22 caliber rifle round. The guy didn't even know he'd been shot. When the coroner's report came back, we found that he'd been shot in the leg and the bullet tracked through his torso shredding everything in between. There was really nothing we could've done, but that was a serious "what the heck just happened" moment.
My grandmother has had diabetes for about 20 years, and takes a handful of meds to help control it. About 10 years ago, she developed a persistent cough. It wasn't bad, she said it felt like a constant tickle in the back of her throat.
She went to her doctor to find out what was going on, and he ordered a battery of tests concerned that she was developing pneumonia, lung cancer, etc. All the tests came back negative, so he prescribed a cocktail of pills to help combat it. Over the span of 5 years, she had tried about 35 different meds and none helped.
One day when she went it for a routine check-up, her normal doc was out and she saw one of the on-call residents. He looked at the barrage of pills she was on and asked why. When she explained, he replied, "Oh, the cough is a side effect of this one particular drug you're on to regulate your insulin. If we change you to this other one, it will go away."
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My first week of my intern year (year one outside of medical school, when you're on call overnight and all that, AKA "Season One of Scrubs"), everyone "signs out" their team's patients to the doctor on call overnight. So that doctor (intern, with an upper-level resident also present overnight to supervise) is covering many patients they hardly know, maybe 60 or more. The situation was that a patient with dementia, unable to really communicate with people and clearly 'not there' but conscious, arrived from a nursing home with I think some agitation as the original complaint.
Basic labs ordered in the ER show the kidney function is worse than usual, which could be due to many things, but what really MUST be distinguished is between 'not enough blood pumped forward to the kidneys and rest of the body' (e.g. heart is failing and it's backing up into the lungs) VS 'not enough liquid in the blood TO flow' (e.g. due to vomiting a lot or something). This is critical to distinguish because for the first you give medicine to make them pee out the extra liquid, and in the second you give more fluid. Either treatment for the opposite problem is catastrophic. Fortunately it's usually easy to distinguish 'wet' from 'dry', based on listening to heart and lungs, chest x-ray (is there 'congestion' evidence?), blood pressure and heart rate (tend to drop BP and raise heart rate upon going from laying down to standing positions if you're too 'dry'), looking at neck veins while sitting up at an angle (they bulge if too 'wet'), and so on. This patient was unable to cooperate with exam, answer questions, and the X-ray was sort of borderline (unchanged from the last x-ray maybe several weeks ago). My resident instructed me to sign out the patient with instructions to continue a 500mL saline inflow, then re-assess to see whether the patient looked more 'wet' or less 'dry'. I signed this out, and forgot to make the order to stop the saline after 500mL, so it ended up running slowly in all night. The intern on call (also first week as doctor) forgot to re-assess at all or shut off the saline if it had been noticed because so busy with new admissions. We'd also ordered 3 sets of 'heart enzymes' meant to diagnose a heart attack, one reason for a patient suddenly getting 'wet' (i.e. heart pump failure), since the EKG was not interpretable (had a pacemaker which makes it impossible to tell). Lab messed up too, because hospital policy was that if the first set of 'heart enzymes' was negative, apparently the 2nd and 3rd sets, each traditionally spaced 6-8hrs later to catch a heart attack if it starts to evolve and become detectable by blood test, were both cancelled.
I came in and first thing in the morning checked on this patient, who was screaming things nobody could understand and the nurses had chalked up to dementia and agitation. I checked the labs and saw the second and third heart enzymes hadn't been done. I went to the bedside and saw the IV fluids still running. I immediately ran to the overnight intern, who said things had been so busy and nobody had called to notify that things were wrong. We stopped the fluids, immediately got a heart enzyme test, learned this patient was by now having a massive heart attack made much worse by the addition of IV fluids all night to this frail failing pump. I can't get the screams out of my head, and cried a lot and was pretty depressed for a few weeks at least after this. The patient died because the status ended up being decided as not to resuscitate based on what the nursing home had on file, although no family members were known at all. This patient was totally alone, and spent the last night of their life in physician-induced agony. But I acknowledge the failure of two interns, the nurses, and the lab. Ultimately the blame fell on the lab and I think someone was fired, but I made clear to everyone that I felt to blame and wanted quality improvements made to prevent future errors, or at least catch them early if they happen. That's I think the best you can do when you make a mistake.
There's a Scrubs episode where as I recall at the end there's a brief scene where the ghosts of dead patients representing medical errors follow around the physicians like little trains. It's very poignant, but I can't find the clip. That's what it's like though.
I missed a gunshot wound once. A guy was dumped off at the ER covered in blood after a rap concert. We were all focused on a gunshot wound with an arterial bleed that was distracting. The nurse placed the blood pressure cuff over the gun shot wound on the arm. We all missed it because the blood pressure cuff slowed the bleeding.
I was doing the secondary assessment when we rolled the patient, and I still missed it.
We didn't find it till the chest x-ray. The bullet came of rest in the posterior portion of the thoracic wall without significant trauma to major organs.
The patient lived. But I still feel like I screwed up big time.
Once as a tired medical resident I was called to the ER to admit someone at like 3am. This patient had a gall bladder removal a week ago and now had a surgical-site wound infection. I asked if they'd taken their post-op antibiotics they were prescribed, and they weren't sure. I was getting more and more frustrated with this person preventing my sleep when I decided to use a "pregnant pause" interview technique, and just shut up. This usually results in either awkward silence and the patient saying "uhh what the heck doc" or awkward silence followed by some useful deep revelation.
In this case the guy hung his head low, looked at his feet through unfocused eyes, started to sniffle while his halting voice cracked "I can't read. Never could. Didn't know the instructions they wrote down for me and didn't know I had medicine to buy. I didn't ask them because I was embarrassed."
Illiteracy haunts rural and urban places in most countries. Those folks aren't reading this, and they depend on our patience and understanding, and acceptance, to detect and bridge that vast communication gap. That's what stuck with me.
When my dad was a resident he had a guy come in with a gun shot wound to the shoulder. The guy had been caught with another man's wife and had been shot while running away naked. In addition to the shoulder, the patient kept saying he had been shot in the gut. Dad searched all over and couldn't find a wound. But the guy kept complaining about excruciating pain in his lower abdomen. X-ray revealed that, indeed, there was a bullet in the abdomen. Took a while to find, but my dad finally found the entry wound... The guy had been shot directly in the butt hole. Swish.
A few years ago, I saw something very similar on ER. Guess if enough people get shot, there are bound to be a few one-in-a-million shots.
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Not a big mistake but definitely awkward at the time. I was gluing up a lac on a 14yo girl's forehead. Anyone who has used dermabond before knows that stuff can be runny and bonds very quickly. I glued my glove to her face. Her mum was in the room, and I had to turn to her and say "I'm sorry, I've just glued my glove to her face"
Dentist here. I was performing a simple extraction and preparing for the case when I didn't realize that I had the xray flipped the wrong way the whole time. I was viewing the film backwards, and pulled out the wrong tooth. When I realized my mistake I started freaking out, only to find out that by some dumb luck, the tooth I extracted had to go as well.
For the record, this happened in dental school, so safe to say it was a learning experience. It was my first and very last time to make that mistake.
As an ICU nurse, I've seen the decisions of some Doctors result in death. Families often times don't know, but it happens more than you'd think. It usually happens on very sick patients that ultimately would have died within 6 months or so anyway, though.
Procedural-wise, I have seen a physician kill a patient by puncturing their heart while placing a pleural chest tube. It was basically a freak thing as apparently the patient had recently had cardiothoracic surgery and the heart adhered within the cavity at an odd position. I'll never forget the look on his face when he came to the realization of what had happened. You rarely see people accidentally kill someone in such a direct way. Heartbreaking.
My first day as a camp nurse for people with intellectual disabilities I gave 9 pills to the wrong guest. I didn't know who I was looking for and asked my friend to send out the guest. His hypochondriac roommate walks out, tells me he is the person I'm looking for, I asked my friend for confirmation who THOUGHT the correct person had come to me and confirmed from afar that it was, and I administered the meds. He had a LOT of drug allergies. Stomach dropped when the actual person I was looking for came out 12 seconds later.
Luckily, we called poison control and most of the pills were vitamins and the ones that weren't were either similar to ones the guy was already taking, or in therapeutic low-dose form. He was fine and still continued to ask for everyone else's pills at all times.
Worked there two summers and thankfully had no other disasters like this one.
I had a 9 year old girl brought in one night with her parents complaining of fever and respiratory distress, presenting with coughing and wheezing. The kid was really out of it and the parents were very upset. I thought it was Bronchitis, but I admitted her and ordered treatment for her fever and cough as well as throat cultures.
I was with another patient when the kid started hallucinating, sobbing and spewing everywhere. I figured it had to do with the fever, so I packed her with ice, but she died maybe a half hour after that. This wasn't my first death, but it was one of the worst. I couldn't tell the stiff neck since the kid was out of it. She also couldn't tell me anything else that would point to simple or complex seizures.
She died of neisseria meningitidis. Completely wrong diagnosis. To make matters worse, we called in all her school mates and anyone else we could wake up just in time to see three other kids go. The rest got antibiotics quickly enough.
Probably my worst day in medicine.
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My brother is a surgeon, and during part of his residency, he had to work in the pediatric unit. He was working with two newborns. One was getting much better and fighting for life. He was going to make it just fine. The other baby was hours from death. He wasn't going to make it. My brother was in charge of informing the families. My brother realized about 15 minutes later that he had mixed up the families. He told the family with the healthy baby that their baby wasn't going to make it, and he told the family with the dying baby that their baby was going to be just fine. He then had to go back out to the families and explain the situation to them. How devastating. To be given a glimmer or hope and have it ripped away from you not even an hour later. That was most upset I've heard my brother. He felt destroyed.
Although I am a doctor, this was NOT me but another doctor I know.
A patient had gone in for surgery on their right knee. The surgeon did surgery and everything was fine except he did the surgery on the wrong knee. Fast forward a few days and the patient returned for surgery on the correct knee. The surgeon did surgery on the patient's knee and forgot a sponge in the knee. The wrong knee, once again.
I worked in a digestive health clinic for a year or so to build up my med school application. I was a gastroenterology tech and obviously worked with many doctors, including my dads doctor (father has crohns). He preceded to tell me about an incident with one of the doctors that I worked with everyday. Apparently he was performing a colonoscopy on a woman and accidentally went into the wrong orifice. These colonoscopes are hooked up to video screens and air/h20 supplies so the doctor can inflate the colon with air so he can have a better look at the lumen of the colon. Apparently this doctor mistook the cervix for cancer and preceded to take multiple biopsies of it. He also put so much air in her that both of her fallopian tubes ruptured and she had to have an exploratory laparotomy. Man his face must have been red.
When I was a new paramedic, we were called to a house for an unknown problem. We arrived and found our patient unresponsive but breathing on a bed. A friend of his found him after he hadn't returned his phone calls- they were going out to do something that day, and he found it weird that the guy hadn't called him yet, so he had gone to his house to investigate. The patient didn't have any pill bottles laying around, and his friend didn't know anything about the patient's medical history. So, I loaded him up into the ambulance and started transporting to the hospital. Started an IV, did an ECG, drew blood work, the whole work up. Get him to the hospital, and the first thing the nurse asked was "what was his blood sugar level?" Oops. Forgot to check it. Turns out, it was incredibly low- which is completely treatable, and probably wouldn't have required transporting him to the hospital if corrected on scene. Every patient gets a blood sugar check now.
I do HIV testing and once I showed up to work super tired because I couldn't sleep the night before. This guy comes in for a test, we go through the pre-counseling and then I tell him to step out for a few minutes while the results come up. Once he comes back to get his results, I tell him to take a sit and the first thing that came out of my mouth was "Your results are positive" and then I saw the look on his face and that's when I realized I screwed up. I then said" Oh no no no, I meant to say negative." I almost gave the guy a heart attack.
This isn't so much a medical error, but a time I feel that I failed my patient. I was on my first clinical rotation in a rural Emergency Room, and a woman came in with a miscarriage, her second one. While we were talking she mentioned she was new to town, didn't know anyone, and her husband was away for the weekend. When we told her the diagnosis, her eyes became teary, and then we left to make arrangements. The doc didn't say he was sorry for her loss or comfort her in any way, which I instinctively wanted to do.
When I went back to her room to give her appointment time, she was in pieces. It really gets me. The five seconds it would have taken me to say those words, put a hand on her shoulder, call someone, or just offer some tissues, ugh anything but I didn't do it. Instead I let my fear of not knowing if I would be showing too much emotion or slowing down the doc, stop me from being human. The silver lining is now I do what my gut tells me. I've soothed babies from exhausted parents, picked up crying family members off the floor, and even discussed comic book heroes with kids getting stitches because that's the kind of person I am, and doctor I want to become.
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I'll tell two stories - a funny one, and a non-funny one.
I was working as a pre-registration pharmacist in a community pharmacy based in a supermarket. A boy and a girl come in, nervous as hell, and step up to the counter. They're teenagers, probably 17-18 or so (in the UK age of consent is 16).
The boy asks "Can I have some condoms, please?"
I'm serving, and we keep the condoms at the counter. They come in packs of threes, tens, and twenties. So I smile, try to be reassuring, but I need to know what they want.
"Sure," I say. "What size?"
The boy turns bright red, but his girlfriend nudges him. He starts estimating with his hands. "Uh... about...this long?"
The second story I'll never forget. I was in a cancer clinic doing follow-ups. I'd just messed up a drug choice (I was under supervision, so it was fine), and wanted to try and ask something smart to the oncologist. So we're in a consultation with a woman who'd had a mastectomy, and I asked the probability of recurrence of the cancer.
Crap, that was stupid. Because the oncologist then had to answer, and probably be very conservative, and scare the crap out of the patient. That really destroyed me. I felt like a total jerk.
I'm a lab tech and used to work in Histology when I was new. I got a skin biopsy specimen and that day I was embedding, basically putting the fixed tissue into wax so it could be mounted on a cutting block to slice 3 micrometer sections for staining. It's very important what side you place "down", based on how it was cut out of the body. Well I messed up and placed it sideways instead of down. The person cutting the tissue couldn't tell and ended up cutting through the tissue. This was a problem because the patient had skin cancer and they were looking at how far it had spread. Since it was cut too deep they couldn't see the edges anymore. This means the doctor had to cut a bigger piece of skin off to be sure they got it all. That's when I found out it was a skin biopsy from the patient's nose. This patient had to have a bigger, potentially unnecessary, piece of skin from his face cut off because of me. I was horrified and learned my lesson that day on how important it is to be certain of embedding technique.
I'm a Cardiac Cath Lab Tech at another hospital, I've been in the medical field for almost 6 years. I was being cross trained into Computed Tomography recently and was thrown into my first night shift by myself after a quick month of training. I had a script I spoke every time I would hook someone up to our power injector for a contrast study (The weird stuff that makes you feel like you pee all over yourself). The injector I used in Cath lab is a HELL of a lot bigger and scarier than this little thing, but they are still dangerous as hell. I also don't worry about blowing IVs in cath lab since we normally go through a much tougher femoral or radial artery.
We do two test injections of saline, one by hand and one my the injector to make sure the IV is patent and will tolerate the injection. 99% of the time this works and everyone is hunky dory; if it blows now the body will simply absorb the saline and you might get a bruise so no big deal. This time however the IV blew RIGHT at the beginning of the Contrast injection (Your body CAN'T absorb contrast in this fashion) and the little pressure waveform on the injector remained "normal" looking. She didn't once cry out or scream as I injected 100cc of Iodinated contrast agent into her forearm and I only noticed something was off when I started my scan and saw ZERO contrast in her torso. I aborted the scan thinking the IV blew outside of the patient, walked into her quietly sobbing inside of the machine with an angry swollen arm about the diameter of a grapefruit. I pulled her out, wrapped a hot water soaked compress around her arm, held it over her head and rushed her back to the ER. I found out later she had to go to surgery for it and has long term nerve damage from the compartment syndrome she suffered. I've had people die on my table, I've been on a code team for my entire term in Cath. Lab ( I respond to Code Blue/ Cardiac Arrests) and see death and mutilation every day at my Level 1 Trauma hospital as the night tech. This one stuck with me since I felt I was directly responsible for it despite being cleared. It caused me to change my WHOLE approach when doing my contrast studies. I tell people to SCREAM bloody murder if their arm does more than burn now when I inject. Insult me, throw a shoe at my window, hit the big red EMERG button on the wall, anything so I don't disfigure someone again when my safeties fail and my machine lies to me. Sorry for the run-on, I'm tired after a 16 hour shift.
16 years ago when I was a medic in the military. This one Marine who came in for Physical Therapy seemed overly depressed (more so than usual). He had bad nerve damage (amongst other injuries) where he could touch his leg and it felt like someone was touching him in the back.
I was more focused on the therapy that day and was excited he was making progress. He didn't seem happy about the progress and made a comment about how it won't matter. I also recalled when he left I said I would see him next week and he didn't say anything and just left.
He hung himself over the weekend. I still wonder if I had paid attention to his comments and not had dismissed them as him having a bad day maybe he'd still be alive? Then again mental health issues were still seen as a defect when I was in so would he even have accepted mental health treatment?
Sorry for rambling but I now pay attention to friends mood swings and signs of depression. Just wish I had done the same 16 years ago though.
I am a nuclear medicine technologist working in a PET department. I deal mostly with cancer patients. Prior to exams, I'll ask the patients why they are having the test done and for any other vital information. One day, a female patient told me she found a lump, had a mammogram, a biopsy, and it turned out to be stage four invasive ductal breast cancer. Having confirmed the information I had on my sheet with the patient, I made the mistake of saying, "Sounds good." To which she replied, "No, it's actually pretty freaking terrible," and she broke down in tears. I will never say sounds good again when a patient tells me his or her diagnosis.
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If you work as a physician in any acute setting, don't dress up for Halloween. My supervising resident had to tell a family that their daughter had cancer while dressed as Cat in the Hat. (respectfully, he took off the hat.)
While being a student I was left alone in a small hospital in the emergency department (this shouldn't happen). I admitted an older man with upper abdominal pain on the right side. Didn't seem serious at all after I talked to him, so I scheduled an ultrasound and called a surgeon to check the patient.Who agreed with my initial diagnosis. Everything was going fine until about 30 minutes later the patient suddenly died. We tried bringing him back but it had no effect. This happened a long time ago, but it still kills me every time I think about it. I'll never trust a simple upper abdominal pain again.
Not really a serious outcome but I'll never forget my first mistake as an EMT. Patient was in the back of the ambulance in a gurney, he required oxygen (he's human afterall) via cannula (little nose thingys). Normally the gurney O2 tank is much smaller than the house tank on the ambulance so we generally switch over the gurney to the ambulance tank. So basically there is now a small hose attached to the wall of the ambulance that feeds the patient delicious oxygen to his nose. This being my first time I forgot to switch back the hose to the gurney and upon removing the gurney from the back I essentially choked the crap out of his face when the hose tightened. Poor guy, he thought he did something wrong. I explained to him what happened and then he laughed about it. Found out later he still tried to sue. Ah well.
I was still a new EMT and had a new Paramedic as a partner. We got a call of a man with no pulse. We arrived and find a 350ish pound man in the middle of a water bed, no pulse. So the new Paramedic did a quick look with the paddles and decided to shock. The shock creates a muscle spasm and set off a series of events which led to the patient being wedged between the water bed mattress and frame. It was impossible for 2 of us to unwedge him, although there was a brief discussion of cutting the mattress and letting all the water out.
Never shock someone you can't lift, on a water bed.
Med student here. A few years ago, when I was working as a medical assistant in an interventional pain management clinic, I was asked by the doctor to place a grounding pad (a sticky pad like they use for EKGs) on the patient's leg during a radiofrequency (RF) nerve ablation procedure. The patient had some lotion or something on her leg that was keeping the pad from sticking properly, but it seemed to be mostly well attached and I didn't want to hold up the procedure to get another pad or clean off the patient's leg. The pad ended up partially coming off right as the high-voltage RF was being applied, causing a small burn on her leg. There was no lasting damage done and the patient was very understanding, but I still felt horrible. It was the first time I had caused harm to a patient, and it could easily have been avoided had I just spoken up. Now I never hesitate to say something if I have even a slight feeling that something is off. Nothing is more important than a patient's well-being.
I was a medic in Israel and most of the time I was on a special ambulance for extreme emergencies or dangerous runs. After an overnight shift with that one I overheard that one of the morning shift medics didn't show up for a regular ambulance so I offered to take his spot. Well I didn't realize at that moment that the driver and other medic were both very orthodox religious but when I did I said whatever and went with them. On the ambulance there's a hierarchy and in this one I was on the bottom rung mostly because I was only 18.
We get a call for an unconscious woman at a bus stop. We get there and it's a visibly homeless woman who's not breathing, has a very weak pulse, and a locked jaw. In this case you're supposed to break the jaw to open the airway but the other two refused to because they were men and she a woman and they physically stopped me from intervening beyond trying to tilt her head back. We watched her die and called the coroner and took off immediately after they arrived. I stopped working with them immediately after and went home. The next day I filled a complaint but it wasn't taken seriously other than I wasn't allowed to be on their ambulance again. I'll never forget that call.
When you're a kid most adults will tell you one thing or another is "cool" and "fun." Odds are you're too young to form any kind of opinion on the matter one way or another. You're a kid, right? You don't know what you're eating for breakfast. However, when you get older and form that larger worldview, you realize that yeah, maybe that one time when you were a kid actually wasn't fun.
These are those stories.