medical opinion is that sepsis was not the cause of death despite the family's insistence.
it is likely a rare condition that the doctors missed. this case is sad but being fixated on one diagnosis and building the case around that is just trying to pin blame.
It may be that the ER's rapid throughput meant they adhere to the heuristic quoted in the article
"When you hear hoofbeats, think of horses, not zebras."
-- Anon. (saying in medicine)
whereas here, it was the (more rare) zebra, but nobody could take the time to do DD (differential diagnosis, i.e. to tease apart what can and cannot be the case).
This is stated as the likely result in the article, complete with the quote.
The article notes that the ER, at that stage of the visit, is not tasked with a diagnosis but deciding whether to admit to the hospital or discharge.
The complaint is that, sepsis or not, horse or zebra, the symptoms presented were severe enough to warrant further tests (such as a chest x-ray, if for no reason other than to rule something out) as part of a hospital admission. Those tests might also have been inconclusive, and the patient might still have died, but it would have at least reflected the severity of what was presented.
Instead, in a chaos of paperwork and a supervising physician who overruled every warning flag in favor of discharging the patient, the kid got sent back to die alone in his dorm room.
This article brought up the sickening memory of taking my frail elderly mom to the er with similarly severe-but-general symptoms.
The er was crowded and the hospital was crowded. The er clearly couldn’t treat her beyond basics, she needed to be admitted and monitored. But, as a sympathetic resident told me before mysteriously disappearing “there’s no space upstairs, I’ll try to get your mom in somehow”.
I worked with EHRs at the time and knew how to advocate. They kept trying to discharge my deeply ill mom without explanation and bumping into my objections, I was talking to a different nurse or social worker or resident every 3 hours round the clock. I felt scared to leave even for a short time lest they expel her.
In the end, I needed to go home to sleep and they discharged her at 6am, and when I arrived they had her bundled up and already waiting to be taken home, shivering and ashen. All they told me was that there’s no diagnosis, no reason to admit her and no beds anyway, she just needs to rest and have fluids, try urgent care if needed.
Multiple social workers sympathetically assured me and my mom’s aide that we were good people for being up to taking care of my mom at home, so they could tick a discharge box. We emphatically were not.
In the end, eventually, she was ok. The experience was harrowing. Many people talked to me but no one engaged with us, the interest was clearly in getting my mom out. It felt cruel and uncaring.
I’m surprised the article doesn’t address the “refusal to admit” angle. It used to be that you could admit patients for care and monitoring without a diagnosis, but this simply isn’t a thing anymore. So, deeply ill people who for whatever reason don’t have access to adequate care and monitoring from a caretaker at home are simply surrendered to their fate.
Hospitals are fundamentally paper pushing bureaucracies that systematically don't give a fuck about patients, and the "case managers" and "social workers" are the worst of the lot. A hospital gave my dad covid in the middle of 2020, then insisted he be discharged still covid positive and unable to stand on his own (the PTs had just let him languish). That was some great public health policy right there. The only consolation was that it was summer so I could keep good airflow through the house. I avoided getting it, as far as I could tell. Found a freelance aide that didn't mind the rona, and we eventually got him back on his feet. And once you see how abjectly horrible this system is, you can't avoid noticing all of those terrible dynamics even in much lower-stakes interactions.
They key element was the introduction of financial decisions into healthcare. This is all in the name of 'efficiency' and never mind the body count. The best thing that can happen to a health care worker is to be subjected to the system themselves.
The health care worker is not the one in charge of these decisions though. I don't consider an executive or administrator a "health care worker" so maybe that is who you mean?
IME, health care workers (doctors and nurses) often defend many of the habits and attitudes encouraged by the system and hated by patients, because the pressure on them has banded them into an "us vs them" or "soldier vs civilian" mentality. Also because the current situation has kicked off a cycle of antagonism between them and patients and especially the people advocating for said patients.
> Also many families try to push elderly to hospital for few days.
And rightly so. As people age and their health deteriorates, often a few day's monitoring and nursing care can forestall downward spirals, or catch sudden downturns so family can react appropriately, instead of the usual sudden crises and desperate scrambles. This is nursing, and hospitals used to do it, which I think is what your comment implies. But these days, without the right golden-key "diagnosis", nothing happens, and those diagnoses are certainly deployed "strategically".
There's no other accessible institution that really provides this kind of care, thus dumping responsibility on the beleaguered "community", as the social workers call it. If you happen to have insufficient wealth and willing empowered family to take care of this, I strongly suggest not getting sick. Or old.
Read all the issues with his diagnosis. One way or another the staff wasn't doing what the record says they did. How could you possibly get to the diagnosis if the tests your claim ordered was never done?
I am an inpatient RN. This conversation is interesting for several reasons: laypeople, unless in hospital as a patient frequently, will have no idea how the "systems" in a hospital intertwine and work together - if we're lucky enough to have them do that. (I wish medical professionals had the energy to talk more about the minutiae of their work just so people better understood.) The "systems" I'm talking about are specialties and roles as well as computer this and technology that. Ethics taught to administrators as well as coders would change a LOT about what we are charting - fact is, hospitals are doing more today to cut costs and avoid liability than they are doing to put patients first. This is obvious just by the fact that they keep declaring they are putting patients first. Rule of thumb: the more the thing is advertised, the less likely it is true despite the understanding that THAT thing is extremely important to their target audience. (not to mention outcomes and statistics show who is getting good care and who is not -lots more to do with finances and financial resources than evidence-based practice, seems to me.) To the point of this article: While I'm charting, I get pop-ups CONSTANTLY. Most are from the software company wanting to give me a tour of the programs features while I'm literally just trying to find a note written by physical therapy, or chart vital signs - I would LOVE to have a proficient skill in navigating EPIC but no hospital where i've worked has given me training beyond the first week. No return to chart training after I've worked with their system for a while, later, when I would know what I'm looking to improve. Other pop-ups are for sepsis alerts as this discussion is about, or (for a RN) fall alerts or skin alerts... All the things that are part of my job and training to be regularly assessing. Here is my summary: What I have seen, for docs and especially for RNs is very obviously just micro-managing to insane degrees of interference, when what works to achieve the right process and best outcome is solid training, retraining, accountability by real people and with respect, and excellent leadership. I DID once work at a hospital where they had enough staff to follow up, answering questions staff had (nursing care or software hacks) and -most important- leadership that did not intimidate, and that could and would talk with the staff member not meeting standards, in real time, getting them past whatever hangup or misunderstanding gets in the way of excellent practice. Follow up and follow up again, with the attitude of teaching (versus punitive micro-management by those whose priority is the bottom line) and supporting the staff to do the right and best thing. Pop-ups and multiple clicks to say "ok" and "yes, I really do mean to do this thing" and "for real please confirm!" add too many wasted minutes, interrupting my thought processes every day day when seconds count for someone's life-saving treatment. I don't know if there is any other industry outside of medicine and nursing where the institution itself literally just adds one road block in front of another, keeping us from focusing and doing what our critical thinking and training have taught us to do. ...don't get me started on Moral Distress and Secondary Trauma because of ignorance around letting us care. . .
did you read the article? i have a medical background and his hematology results does not support sepsis. the family pointing blame at the hospital for ignoring the sepsis automated warning is barking up the wrong tree and probably why the hospital ignored them.
not saying the hospital is faultless because they clearly failed in this case but as in any courtroom if you charge a criminal with the wrong crime you are bound to lose.
I think the real implications are much more chilling. As much as we like to believe otherwise, there is always a chance that a seemingly-healthy college kid will drop dead of something that even the best doctor wouldn't have anticipated.
And as much as we would like to believe otherwise, the modern healthcare system is riddled with problems that no technology or checklists will fix. It doesn't take someone's death to verify this- just go read your own charts and discharge papers. Even for something relatively routine there are bound to be inaccuracies. Doctors know this, which is why they spend so much time doing handoffs and interviewing patients.
We pretend that the medical 'record' is infallible, helping to reduce the mental load on doctors while protecting them from liability. But as this case shows, the 'record' is both inaccurate and not useful in showing fault. It's a paper tiger. I'm not saying we should scrap the whole system, but I do think it needs to be examined in a data-driven manner.
As a surgeon, one truly humbling fact about humans is we are simultaneously incredibly fragile and impossibly resilient. You will be shocked at what people can survive and what flimsy things kill people
Almost 30 years ago I went to a Penn and Teller magic show. They did their bullet catch (classed up but basically the same trick people have been doing for a century) and other stuff I don't really remember.
The trick I vividly remember was just Penn standing behind a table, putting a piece of green cloth (like a surgical thing) over a water balloon, and then giving a long speech of all the damage that friends of his had survived, as he stabbed the balloon (under the cloth) repeatedly in time with his speech, and talked about the wonder of medical science, and how doctors he knew had saved people from all these horrendous accidents and damaging the balloon in sync with every example.
And then he removed his hands from the table, holding them up to the audience, leaving the balloon still under the surgical barrier, and said "And the other thing that doctors will tell you, if get a couple of beers into them, is that sometimes people just die for no reason at all." And the balloon collapsed right on cue.
I can't seem to find a video of it but I remember it clearly.
Technology can fix plenty. I have narcolepsy and was able to diagnose myself after multiple doctors had failed, and luckily I finally found a specialist in narcolepsy who could actually confirm it. Wouldn't be possible without Google (which any of those docotors could have used but didn't). I would probably still be searching for a doctor to actually do his job. Technology can solve plenty of problems. What we need to do is get the doctors out of the loop.
And for every person who correctly diagnoses themselves despite at odds with what a doctor is telling them, you have 10 people undergoing unnecessary, dangerous treatments because the misdiagnosed themselves.
I was in my case (and I didn't even have AI back then) after multiple doctors failed miserably. Of course I needed to get the actual doctor diagnosis to get insurance to pay for my treatment, but that's bureaucracy, not medical science.
No. I can transcribe every interaction with 100% accuracy, but if those notes aren't used in any way it's not data-driven. This article shows that the notes are inaccurate, suggestions using the notes are routinely ignored, and that doctors and legal review think this process is acceptable. There is no professional or legal liability if the records are wrong. And yet if you talk to a medical professional they'll explain that the records are to establish a legal paper trail if anything goes wrong.
Some executive(s) have been told that detailed medical records are the solution to so many problems in modern medicine. But they lack either the guts or the expertise to make sure that these systems are actually accomplishing what they set out to do.
>suggestions using the notes are routinely ignored
Of course. The records are known to not be 100% accurate. Any conclusion you derive from them will be faulty.
>There is no professional or legal liability if the records are wrong.
Again, of course. In many cases it may not even be possible to show a record is incorrect. For example, if the record doesn't say a test was performed, but the patient insists that it was, is the record wrong, or is the patient mistaken? Or a doctor could incorrectly write down something that only he saw, such as a blood pressure value on a gauge.
I would guess a key obstacle to eliminating all these inaccuracies is that doctors don't see strict record-keeping as actually useful in helping patients. Every minute that they're taking notes of dubious future utility is a minute they could spend seeing a patient.
The real issue is the administration of the hospital sees every minute the doctors spend taking better records instead of seeing another patient as a loss of ability to bill someone's insurance for that time.
I'm sure there's many doctors who would like to take better notes if they were allowed the time to do so.
Maybe the case for better records reducing costs to insurance by assisting in prevention / early intervention is a path forward?
People die of missed sepsis all the time, so if you want to lean on your "medical background" to claim this was not the case, you better elaborate what exactly that background is
OK fair enough, but the detail in the article about the hospital information system and 'Note bloat' are still very interesting to me. I've seen stories like this before - when everything triggers an alert, people start ignoring the alerts. (edit: it was this story: https://medium.com/backchannel/how-technology-led-a-hospital... )
it is likely a rare condition that the doctors missed. this case is sad but being fixated on one diagnosis and building the case around that is just trying to pin blame.