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  1. GingerCoffee
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    Ebola in Dallas, blaming nurses & "the system" for the doctor's error, and misc.

    Discussion in 'Debate Room' started by GingerCoffee, Oct 3, 2014.

    I thought we had an ebola thread but it was only something discussed in a thread on the world falling apart. So this is an ebola thread, and anything related.

    First, the public's over-reaction stoked by the news media selling fear mongering sucks. People need to calm down. There's plenty to talk about there.

    But the thing I've been stewing over in the last couple days (and why the thread is in the debate room) is the Dallas hospital at first trying to throw the nurses under the bus (probably unintentionally) when it came out the nurses did ask the patient, Duncan, his travel history before the patient was sent home on antibiotics.

    Now they are trying to blame the system. I don't believe them. Someone is making excuses for the doctor who failed to ask, probably didn't even look at the nurse's history on the patient.

    What isn't credible is that these nurses have been asking and recording patient histories all this time and no one noticed the docs can't see those histories?

    How did no one notice such a major flaw until now?


    But even if true, that means the doctor who didn't see the nursing history on the patient also didn't ask the patient for travel history. Explain how the doctor who didn't see the nurse's notes didn't then either ask the question him/herself or look for said nurse's notes?

    The nurse who did a proper job, instead of being credited, is having to hear crap on the news like I heard this morning, "why didn't the nurse tell the doctor in person?" All the while the doctor is excused.

    UPDATE: For the first time now, an MD on MSNBC is stating that the doctor should have asked, "you never rely on someone else to take the medical history".

    FINALLY!
     
  2. GingerCoffee
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    Now the hospital is blaming the patient.

    Hospital reverses explanation for fumbling Ebola case
    Actually they blamed the nurse first, then the computer system, now the patient.

    Everyone makes mistakes, I'm not saying this doctor was any worse than thousands of doctors and nurses across the country who make mistakes, we're all human.

    My complaint is, why isn't this hospital and doctor saying, the doctor made a mistake? It's probably not the first patient a doctor somewhere in the country discharged that had ebola warning signs. It's just the first one someone sent home that actually had it.

     
  3. Ben414
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    Ben414 Contributing Member Contributor

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    I don't have any medical training, but I was wondering how the doctor didn't consider his travel history. That seemed like an obvious thing even for me.

    I have no knowledge of how hospitals are run, so maybe you can answer this for me, GingerCoffee: Are doctors forced to go through a checklist system before they take actions such as releasing a patient?

    I heard a person somewhere talking about a digital checklist system that was created to help doctors avoid these casual mistakes that inevitably happen over the thousands of patients they will treat. They tested it in a study in some major hospital, and the amount of casual mistakes was drastically reduced during the test.
     
  4. Lewdog
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    Lewdog Come ova here and give me kisses! Supporter Contributor

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    Funny when I had stomach problems years ago, one of the first questions they asked was if I had traveled outside the country recently. Shouldn't this be a pretty standard question to ask people that come in sick?
     
  5. GingerCoffee
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    Medical mistakes (that includes nursing mistakes) are just the nature of the beast. I know this stuff because it's my area of practice. But I can't tell you how many doctors and nurses are not paying attention to current infectious disease epidemiology.

    ED doctors have a hell of a lot of things to keep in their retrievable memory. They tend to send mildly ill people home, knowing if it's serious, the patient will return.

    I do think an automated history and exam checklist is sorely needed.
     
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  6. GingerCoffee
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    It is a standard question, for more reason than just ebola. What happens is people get complacent. Ordering an ebola work up is a big deal, your brain has a psychological barrier to calling for one. Probably not so different from the other side of the coin, the patient was likely in denial that he had been exposed. But not quite complete denial because he went to the ED with mild symptoms.
     
  7. KatieValino
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    I kinda feel like everyone freaking out about the fact it is on US soil is making them want to point the finger at someone.

    These doctors are under a lot of strain. At the time this man was first in hospital, the headlines were being dominated by the issues with IS and Ebola had been sidelined. I remember mentioning this to a friend. Now with that in mind, Doctor's do not usually take into account the person could have Ebola. The symptoms are SO generic that even when the patient said he had come from Liberia, the majority of medical staff would think of some other possible cause such as Malaria. Not everyone has been avidly following every detail of this Ebola outbreak. I am not making excuses if there WAS some level of incompetence. I am merely suggesting that Ebola is not the forefront on people's minds when it comes to a fever and muscle aches.

    Maybe it SHOULD be. But that is now that it is raging across Africa. Half the people moaning about this incompetence had probably not even heard of Ebola a year ago. I think if anything should come from the outbreaks in the west, it is rather than try to blame someone and get the CDC general to resign, they should focus on where the PPE failed and what protocols can be put in place to safeguard everyone. Correct the mistakes, not play the blame game.
     
  8. GingerCoffee
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    The news media especially is looking for who to pin the scandal on. The hospital was using PC language to cover their asses that the doctor made a serious mistake.

    I don't think they intended to blame the nurses. They inadvertently blamed the nurses when they thought all they were saying was, a system error occurred. The news media kept asking questions like, "why didn't the nurse tell the doctor." Since the nurses were not the ones to blame the hospital then switched to, "the nurses put the data in the record but the doctor didn't have access to that information."

    Well that cover up attempt didn't work either so they finally admitted "mistakes were made."

    You know how that goes? "Mistakes were made but not by me." In other words it's as if no one was responsible for these mistakes. I imagine the doctor doesn't exactly want to come out and say, "I made the error." Or maybe he or she would but he/she can't because the hospital needs to be careful. They are no doubt looking at a lawsuit here.**

    **Which is unfortunate because it's unlikely it would have made a difference with the patient.

    I agree we all make mistakes, doctors and nurses. However, this doctor made an error he should not have made with any patient at any time. It is standard medical practice to ask a patient their travel history when diagnosing any illness. This doctor did not do that.

    Dallas has an international airport just like Seattle has. Any doctor working in an ED in a major hospital, especially one with an international airport should have been well aware of a potential ebola patient. But I've seen that kind of lack of awareness before. Here's one of many examples I have:

    I take care of exposed EMTs. I do their training or have been involved in developing policies. I have to be aware of relevant epidemics wherever they are. We've had ongoing pertussis outbreaks for years. A few years back when we had an outbreak in our own county, the EMTs reported transporting a patient they thought had pertussis symptoms. So I called the ED to follow up on the diagnosis since the EMTs would need antibiotics if the patient had pertussis. The ED doctor told me, "adults don't get pertussis." 40% of the culture positive cases at that time during that current outbreak in the very county this ED was located in were in adults. Needless to say, adults not only do get pertussis, they were getting it in large numbers because our vaccinations were wearing off and there wasn't yet a booster adults could get (the booster for adults was approved in 2005). I sent him the public health alert and hope he added his name to their email alert list.

    It's inexcusable the doctor in Dallas didn't consider ebola. Had he asked about the patient's recent travel and had he been aware of the Liberia epidemic as he should have been (it's his job to know that) he should then have ruled it out. The reason you do that, even with rare possibilities, is that there are certain criteria that guide your patient's workup:

    What's most likely?
    What can you possibly rule in or out with less invasive tests before you need to do more invasive procedures?
    And what can you not afford to miss?

    Those are guidelines we all follow diagnosing a patient.
     
  9. KatieValino
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    I get that the Doctor made a horrible mistake, but should he lose his job over it? No. Should the blame game continue to be played? No.
    Nothing will be gained from pointing fingers and throwing this doctor to the media circus. He probably feels shit enough as it is.
    Instead the importance needs to be placed on fixing what is clearly broken. And trying to save the lives of the nurses infected as well as the thousands of people suffering elsewhere.

    The media are a bunch of fucktards (excuse the language xD)
     
  10. GingerCoffee
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    Where did you get the idea I thought the doctor should be fired? :confused:

    The point of the thread was to address the wrong blaming of the nurses.

    As for blaming, pointing fingers: the idea is to admit to mistakes, make a record of what happened with the goal of learning from the mistake so it isn't made again. If you (as in the hospital) claim the issue was the patient denying he'd traveled, or saying the travel history was asked but some communication glitch occurred, or whatever, who learns from that false information?

    The nurses took a proper history. The doctor either didn't bother to read the nursing notes and/or didn't ask the question him/herself. No one learns anything from downplaying where the mistake actually occurred.

    The same with the news media beating up on the nurse for getting on the plane with a temp of 99.4 and some ignorant Congresswoman I heard today claiming, "she's a nurse, she should have known better." Yes, she did know better, so she called the experts at the CDC to ask for advice. Blaming the nurse who did the right thing does nothing to prevent the next mistake. Pointing out the problem was that the CDC had some less-than-adequately-knowledgeable person on their end of the line who only read an algorithm and didn't have the expertise **cough-budget cuts-cough** needs to be done so the problem can be corrected.

    Claiming the two infected nurses "breached protocols" when in reality they were given inadequate PPE and inadequate training along with no proper policy does nothing to prevent the next error.

    Hopefully you get the picture. :mad:
     
  11. Cogito
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    Cogito Former Mod, Retired Supporter Contributor

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    Do you think understaffing contributed, in pushing staff (nurses, doctors, and administrators) to take shortcuts and to not continually review protocols or refresh training?
     
  12. KatieValino
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    Not you specifically, the general media reaction to any person making a mistake is to demand their blood and their job and their first born child.

    It WAS wrong to blame the nurses, however, that is taking into account we can believe everything the media says as gospel. If it WERE said, maybe they did it for the greater good? Look at the panic this has created, two nurses contracting it even whilst wearing PPE. People freaking out it could be air borne. People would rather believe it was human error than the virus becoming air borne (not that it is possible). Now that it has been exposed as potential error on behalf of the hospital and doctors etc, now people are panicking even more believing the CDC is not ready for it to come here, no hospital is. I am surprised there have been no riots to be honest.

    There was an incident where a woman collapsed on a bus. Rather than help her, everyone fled.

    That is what we want to avoid, all this furor about who is right and wrong will not help. People need to trust that the CDC can see that the doctor royally fucked up, that the PPE was inadequate and that the contagion needs to be taken seriously. Focus on reporting the facts of the fuck up, where it actually went wrong and then you will have a pretty good solution to the problem.

    But everyone remaining calm and working together to double check the doctors are ready to diagnose this is not a headline maker xD
     
  13. GingerCoffee
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    In this case, no. I don't see any evidence understaffing at the Dallas hospital was an issue. Underestimation of needed preparedness was.

    I do think lower-competency staffing at CDC was a problem. I've called the CDC before for advice and always gotten someone who was knowledgeable answering my questions. To hear the person answering the second nurse's questions was following a written algorithm was worrisome.

    I also think a shortage of beds at the specialty hospitals is a serious issue not only for ebola, but also for all kinds of potentially looming infectious disease hazards.
     
  14. GingerCoffee
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    It's not that the media blamed the nurses. It's that the hospital spokesperson, in an effort to put the hospital in a better light (it's knee-jerk for them to have done that), didn't realize their story would scapegoat the nurses. Like I said, I don't think they intended to do that. I think they didn't consider the ramifications of their "mistakes were made but not by us" story.

    Again, you miss the point. Please re-read my post.
     
  15. GingerCoffee
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    Nurse will fight quarantine order
    Good for her. I'm involved in setting policies for when staff who have been exposed to contagious diseases who are in the incubation period. The rule of thumb is you can't come to work during the time you are potentially infectious. That can be before symptom onset because some infections are contagious before symptom onset. Ebola is not known to be contagious before symptom onset, so with an ebola exposure you don't need to quarantine an asymptomatic patient.

    We know this, and none of the people at the bowling alley or on the subway with Dr Spencer are going to catch ebola. None of the people living in the same apartment with Mr Duncan in the early stages of symptomatic ebola became infected. No one on the planes with asymptomatic ebola infected people became infected.

    And yet people are acting like idiots. Chris Christie was an asshole in an interview about Ns Hickox needing to be quarantined. CDC is caving to political pressure saying asymptomatic people who were anywhere near patients with ebola should self quarantine for 21 days. And that's a shame. Good for President Obama giving a speech right now standing up for the health care workers who have volunteered to take care of these patients.
     
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  16. GingerCoffee
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    In the U.S. battle against Ebola, quarantine rules depend on your zip code.
    o_O

    New York and New Jersey officials are also ignoring the question of why the 21 day quarantine is not being applied to all the health care workers taking care of the ebola infected patients here in the US.
     
  17. GingerCoffee
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    And the news media continues to distort and not ask the right questions.

    There's a court order with a partial quarantine for Hickox, she is not confined to her house. But the news media was expecting her to be confined to her house so they are reporting it as a victory for the state when to me it looks at least like a compromise.

    Then Fox had an 'expert' on who made some legitimate comments but went on to say the infected nurse who flew on the plane and the infected doctor who went bowling made the public not trust self quarantine and doctors and nurses were in denial.

    That's just crap. The nurse asked and received advice from the CDC for her travel and the doctor only went around town before symptoms developed. The media is the one promoting the fear based on false information that the disease can spread before symptom onset, something not known to happen.
     
  18. GingerCoffee
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    Judge reverses the order as unnecessary. Remember SHE HAS NO INFECTION!!

    Now some idiot has started an online petition to have her nursing license revoked. Gee, why not start one to have the witch burned at the stake? :rant::rant::rant::rant:
     
  19. Lewdog
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    Lewdog Come ova here and give me kisses! Supporter Contributor

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    Hmm you should tell us how you really feel.
     
  20. GingerCoffee
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    Hooray for common science sense in the Seattle area:

    A Seattle-area nurse is being monitored for symptoms after treating Ebola patients in West Africa.
     
  21. GingerCoffee
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    Holy shit, are we in the middle ages or what?

    There's a yahoo news article reporting the Maine nurse who fought the unnecessary quarantine will be moving. There are more than 2,000 comments and I just went through more than 100 of them, only one supported her stand. The rest were vicious and ignorant as hell. I posted as much and within minutes it was "hidden" because so many people clicked on thumbs down.

    No one in Dallas except the 2 ICU nurses whose employer didn't provide protection got infected. The 21 days has passed for the last people possibly infected: no infections. No one got infected because Ns Vinson traveled on a plane. Ns Phan's dog did not get infected. Ns Hickox did not develop symptoms.

    But the ignorance, that is epidemic.
     
    Last edited: Nov 9, 2014
  22. GingerCoffee
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    A few more people are starting to stick up for the courageous Ns Hickox in the news article comments. Yay!
     
  23. Cogito
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    Good. Fear is the real epidemic, and make no mistake: it, too, is fatal, especially with the co-infection of ignorance.
     
  24. Simpson17866
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    And to think that a Democrat (Cuomo) and a Republican (Christie) used their government resources to interfere in a citizen's (Hickox) personal life. One shudders to imagine what the quarantine would've looked like with two Democrats in charge :eek::eek::eek::eek::eek:
     
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  25. GingerCoffee
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    Out here on the Left Coast, our politicians and public health authorities had a more level headed approach.
     
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