Medical Malpractice and Confirmation Bias

tuftsThere are a lot of differences between good hospitals and bad hospitals.  It is an all too common trope to claim that one thing encapsulates the differences between good and bad.  It is always more complicated than that one little thing.  That said, if you watch hospitals closely, it is amazing how often you see the best hospitals – the Mayo Clinic, Hopkins, the Cleveland Clinic – owning up to their own mistakes and trying to figure out new ways to conquer them.

Tufts Medical Center also appears to be on that list although maybe more reluctantly and with a bit more dragging of them then we might want.  Specifically, Tufts is attacking a problem that causes malpractice that last November, unleashed hospital and government inquiries that have led to widespread safety improvements in Tufts operating rooms this year and highlighted medical errors involving “cognitive bias” — an area of growing interest among researchers.

Cognitive bias is a pattern of deviation in judgment that occurs in certain situations that, in particular situations, leads to perceptual distortion, inaccurate judgment, or illogical interpretation.  It causes illogical decision making.   You fall prey to it every single day.   You think your son should be the starting quarterback on his high school football team instead of the third string safety.  That kind of bias is ultimately harmless.  The key is keeping cognitive bias at bay when you are making life and death decisions.  This is getting attention in the medial field because some doctors are frequently making life and death decisions.  Cognitive bias errors cause them to exaggerate the risk of relatively low risk medical events and underrating grave risk.  In the process of doing this, doctors sometimes make decisions that are, in hindsight, incredibly irrational even to them that appeared quite rational at the time.

In society, this bias rears its head when we walk though the airport, right? We are spending zillions to prevent the small chance of a terrorist attack.  I’m all for this.  But if we took that same money and put it towards curing cancer and heart disease and improving automotive safety,  we would save countless more lives. You can find more examples in this study.

Specifically, medical malpractice mistakes often occur as the result of a specific type of cognitive bias called confirmation bias.

What Happened at Tufts?

A woman underwent a procedure to solve her back pain.   Her surgeon asked for a dye called Omnipaque so he could see the tubing he had threaded down her spine.  Somehow, the hospital pharmacy didn’t have it so they gave a different one whose label warned against spinal use.   How could this happen? A pharmacist told the nurse that the pharmacy did not carry the one that the surgeon wanted and handed her MD-76 saying, “This is what we have.” The surgeon just figured it was the right one and used it.

After the woman woke with severe pain and seizures, they figured out the mistake.  Her neurosurgeon, bless him, did not play hide the ball.  He told the family of the mistake that was made.

Insurance Companies Pathologically Can’t Do the Right Thing

After the woman died, Tufts’ insurance company owned up to the mistake and told the family they would compensate them.   Wait, no.  It never happens that way.  They wrote the family a letter and said there was no malpractice.  So the family hired a malpractice firm – Lubin  & Meyer which handles a lot of big cases in Boston – to bring a wrongful death claim.  The Boston Globe got wind of it and the case settled pretty quickly.   The take home message, as always: insurance companies are always the worst.

Tufts Does the Right Thing After Prodding

It is a little hard to make Tufts the hero here.  First, they killed a woman. Second, they let their insurance company fight the claim.  Finally, it took a second case and a Medicare investigation for them to make a change.  Apparently, after this debacle, the hospital violated its own protocol in taking out an intravenous tube causing an embolism and heart attack that lead to severe brain damage.

Whoops!  I Fell to Confirmation Bias Myself

Look at how I tried to write this article.  I wanted to praise Tufts because I thought it was a pretty good place.  So I read a Boston Globe article and I created the narrative in my head that Tufts is learning from its mistakes and trying to make things better.  After reading more and learning more, I start hedging my best a little with qualifying language.  But now I realize I can’t make a hero out of the hospital.  They killed a woman, caused brain damage to someone else, and they made a few minor changes.  Big deal.  This should be a post about how they killed this woman and refused to take responsibility for it and how these apology laws in malpractice cases are stupid.  My bad.

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