I saw this in the Boston Globe recently…
This picture from the Globe article has been haunting me.
“When doctors make mistakes the guilt stays with us.”
The article caused me to remember a patient in whom I made a mistake with a central venous line (CVL) 20 years ago. I think about her still. I could have killed her. Even though she survived, I harmed her and I prolonged her hospitalization. I still feel guilty.
It just happens that this article is about a mistake with a CVL like mine was and maybe that is why I am haunted by it. In my career, I must have inserted a thousand CVLs, or more. And this was my only mistake with them. “It is better to be lucky than good!”
Some of the enjoyment of being an anesthesiologist is skillfully performing invasive procedures. Nevertheless, invasive procedures are prone to errors and complications (harm).
There was a time when I would insert a CVL in the operating room, not so much for how it might help me manage the patient, but for the pharmacological/hemodynamic management of the patient later in the ICU. In many of these cases, the CVL was inserted not out of necessity for the data it provides but for the convenience of the ICU staff. Aside from not helping me in the OR, CVLs, like all invasive procedures are a time-consuming distractions and a potential complication. If they are NOT necessary, don’t do them. Let the team that wants one insert it and let them take the risks associated with inserting it (and the guilt if they should harm the patient).
Years ago, I could put in a CVL with just a pair of sterile gloves, a few sterile towels, and using surface landmarks (without ultrasound). That was then. Now, inserting a CVL requires full sterile precautions (gown, gloves, full drape) and ultrasound guidance. All of these precautions are important as they limit infections and vascular misadventures. However, they are time consuming and they don’t help me care for the patient.
A little older and hopefully a little wiser, I now worship at the altar of “less is more,” and I don’t do anything that isn’t necessary for me to take care of the patient.
To my residents… please ask yourself, “Is what I am doing necessary and is it going to help me care for this patient?” If it isn’t, please don’t do it.
In the very least, please don’t do it when we are working together.