Dissection of a TV Show

Screenshot 2014-07-31 17.24.02

Jasmine Latter, 2nd year, puts an episode of Grey’s Anatomy under the microscope and asks if a mistake leading to the death of a patient should always result in dismissal.

We all make mistakes but do mistakes equal incompetence?

In the episode of Grey’s Anatomy, ‘I Saw What I Saw’, one minor mistake led to a disastrous outcome – the death of a patient. In this circumstance Dr April Kepner was deemed responsible and lost her job as a result. Although her colleagues agreed that she was a good doctor, this one mistake still resulted in her dismissal. Despite the fact that firing Dr Kepner wouldn’t bring the patient back, and recognising that the mistake was an unintentional one-off occurrence that could have happened to any of the doctors – this action was deemed to be just in the legal sense. The main reason for this mistake was a simple distraction. In many situations- not just medical, a distraction could lead to errors being made. However, more often than not these errors are small and not significant enough to be picked up therefore may slip by unnoticed with no remarkable consequence.

A fact recognised by Dr Yang at the end of the episode, when she says ‘This could have happened to any of them’ is uncomfortable but true.  Throughout the show, many members of the team had preventable likelihood for error they were just lucky that their mistakes did not have a significant impact on patient outcome. Unfortunately for Dr Kepner, the small mistake she made in failing to adequately assess the patient’s airway was directly related to the subsequent death of the patient. In light of this, can we argue that the punishment Kepner received was just?

Unhealthy Competition

Competition for the most exciting case was a key source of error in this episode, with ‘exotic’ Screenshot 2014-07-31 17.42.06cases demanding more attention than those judged to be run of the mill. The danger here is obvious- the seemingly mundane cases still have the potential to be life threatening. In treating patients like cases instead of being concerned about the overall care of the patient regardless of how exciting their medical problem is- errors quickly arise.

In this instance, instead of focusing on the patients they were in care of at the time, Kepner and Adamson were more concerned about moving onto what they deemed the next, more interesting patient. Moreover, they stated this in front of the patient. This may have led to the patient feeling dismissed and unable to discuss their condition fully. Had they been more professional and kept the patients interest as their utmost concern, instead of being preoccupied with making personal gains or career advancements, the patient may not have died.

We’re All in This Together

The professionalism of the medical team is also called into question when they openly criticise their fellow staff, discussing the friction and lack of co-operation between themselves and their colleagues in front of the patient. This is highly unprofessional and unlikely to give the patient confidence in the department and those working in it. Moreover, the mind-set of ‘us vs. them’ displayed in this episode was not conducive to good patient management. Lack of teamwork and communication between colleagues resulted in the patient becoming lost in the system- uncertainty of roles and leadership led to no-one taking responsibility for her care. The shortcomings in structure of the institution as a whole also contributed to the lack of teamwork and communication. Furthermore, pressure to assist  colleagues with ‘more important’ tasks could also have prevented the patient from being of the utmost concern. Fortunately the situation where Dr Grey was required to aid another colleague did not impede on the care of the patient in question.

Over the Limit

Screenshot 2014-07-31 17.49.33Inability to recognise personal limitations is another cause of poor practice in this episode of Grey’s Anatomy. Both Dr Karev and Dr Grey exemplify this. Dr Karev is distracted by his personal issues with his wife and allows this to interfere with his ability to deal with patients, appearing distracted and incompetent. There is also a breakdown in communication between himself and his colleagues to an extent, increasing the chances of mistakes occurring.

Another example is Lexie Grey’s inability to maintain composure in front of the patient. Her sympathy with a burns victim prevents her from carrying out her job properly and she is asked to leave the trauma room. Her inability to acknowledge her emotional vulnerability despite her colleagues concerns later distracts them and could have affected patient care. In both instances, the doctors allow personal issues to jeopardise patient care thus endangering lives and going against the concept of protecting the patient from harm.

A Question of Luck…?

So to answer the question initially posed: do mistakes equal incompetence?  Mistakes are a natural part of being human so will always be present in a hospital environment. What is important is that we take action where possible to minimise their occurrence and the impact this could have on a patient. In this case, whilst it is true that any of the doctors involved in the care of the patient could have committed the fatal error, Dr Kepner cannot put her mistake solely down to misfortune. It was failure to follow a standard protocol in assessing the patient’s throat that ultimately led to death. This error must be acknowledged and action taken. However, whether this should equate to the dismissal of Dr Kepner is a difficult conclusion to make.

I don’t believe a doctor should be deemed incompetent when they make mistakes but rather on their inability to correct the situation or take reasonable action to prevent it occurring in the first place. The key point we can learn from this episode is that each patient is an individual (and not simply a case) whose condition may change rapidly to more than what it appears on initial assessment. It is essential to be prepared for whatever comes through the door as we never know the impact that a single minute error on our part could have on a patient.

REFERENCES

1. Common causes of medical mistakes adapted from NYMC Medical errors and patient safety: A Curriculum Guide for Teaching Medical Students And Family Practice Residents, 3rd edition, 2003 (Joseph L. Halbach, Laurie Sullivan)

2. Images: Grey’s anatomy, series 6 episode 6- ‘I Saw What I Saw’

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