“I Unknowingly Discharged a Patient Having a Stroke”
By Bryan E. Bledsoe, DO
I’ll never forget her—in fact, I still have dreams about the look on her children’s faces after she died. Her name was Claire,* and she came into the ER where I was working as an emergency physician. She had an old neck collar on upside down and was complaining of neck pain and a bad headache. She was about 60 years old, and I thought she might have had a mental handicap because she had difficulty describing her symptoms. Her son and daughter were with her, and they also seemed a bit slow.
*Name changed to protect privacy
This ER was always busy, and the administration had been pressuring us to move patients through more quickly. I examined Claire briefly and saw no worrisome signs. X-rays of her neck showed nothing wrong; I assumed she had slept wrong or pulled a muscle. So I discharged her with some pain medication and picked up the next chart in the bottomless stack.
The next morning we received a call from an ambulance transporting a female who had suffered cardiac arrest. She was brought into the resuscitation room, where we continued CPR. I didn’t recognize her at first, but then I noticed a familiar-looking son and daughter sobbing in the hallway. I looked at the lifeless patient and almost broke into tears myself. In my rush the day before, I hadn’t listened carefully to Claire’s complaint of severe headache. Now it seemed clear to me that I’d overlooked a symptom of an impending stroke.
We did everything we could, but I knew our efforts were hopeless. After I pronounced her dead I met her son and daughter in the small chapel near the emergency department. I started to explain—in way too technical terms—what happened. Then I paused, and tears came to my eyes.
“I’m so sorry,” I said. “I wish I had ordered a CT scan yesterday. I must have missed something. I’m so sorry.”
“That’s okay,” Claire’s daughter replied. “We know you did your best. Mom said you were a good doctor.” I couldn’t stop my tears now. A few days later, I went to the funeral, where I sat with Claire’s children. Even thought 20 years have passed and I’m now a medical-school professor, I haven’t forgotten.
How to Fix the Problem
I try to impress upon physicians-in-training that medicine is more than using advanced technology to move an endless flow of patients. Every person in the exam room, regardless of social status, is a human with a family, and our duty is to act in that person’s best interest—not in the best interest of insurance companies and hospital administrators, the way I did.
We also need to erase the burden on the ER. Between 1997 and 2006, emergency department visits increased by 32 percent, while reimbursement to hospitals hasn’t kept up. We need more retail health clinics and urgent-care centers. And we need to educate people so they trust these new clinics and use them for all but the direst emergencies.
Until these things occur or other solutions are found, unfortunately what happened to Claire will happen again—and again.
Bryan E. Bledsoe, DO, is a clinical professor of emergency medicine at the University of Nevada School of Medicine in Las Vegas.