Tuesday, February 8, 2011

Don't mention the 'e' word

In the event I find myself cast away on a deserted tropical island and granted one 'thing' (assuming I already have the survival skills of Bear Grylls and a decent Swiss army knife), then hands-down, no question I'd like The New Oxford Dictionary of English.  A risky admission on the speed dating circuit possibly, but there you have it.  I am a word geek. 

So you can imagine my surprise when, reading the news online yesterday, I was stumped by the use of the word error.  I realise my brain has atrophied since the arrival of all those mothering hormones several years ago, chewing through synapses for sustenance.  But seriously, error?

Wikipedia got off to a cautious start.
The word error entails different meanings and usages relative to how it is conceptually applied.
Generally speaking, I understood error meant: mistake; being wrong. But again from the Wiki, there's the whole error versus mistake consideration.  
An ‘error' is a deviation from accuracy or correctness. A ‘mistake' is an error caused by a fault: the fault being misjudgment, carelessness, or forgetfulness.
So perhaps sending a baby home with a broken neck and some paracetamol after a few hours in the Emergency Department was a mistake then?  Because New Zealand's independent Health and Disabilities Commissioner's report concurred with MidCentral Health's own investigation into the incident, ruling out any error in the care or treatment provided to the baby.

An interesting conclusion given the news story (click here to read the article).  
  • A ten month old baby boy and his mother are taken to the local ED by ambulance following a car crash.
  • Ambulance staff suspect a neck injury.
  • A junior doctor tends to the baby, who is discharged some hours later with paracetamol.  The mother remains in hospital.
  • The father returns the baby to the ED the next day because the baby's head is lolling on his collar bone.  He sees the same junior doctor and urges the doctor to give the baby an x-ray.
  • Specialists at Starship, New Zealand's only dedicated children's hospital, view the x-rays and ask the baby to be put in a neck brace immediately and air-vac'd to Starship.

Since then, the baby has had 2 MRI scans, 3 CAT scans, nearly 100 x-rays, one surgical bone graft, and earned the dubious distinction of being our youngest child to be placed in halo traction, which he wore for three months along with a half body cast.

He has become the 'poster child' for Starship Hospital's spinal injury unit. Starship says he's lucky to be alive.

I understand injuries can be missed, especially in very young children.  I also understand that things can and do go wrong, especially in medicine, and most especially, in trauma medicine.

What I struggle with is the apparent misappropriation of every day language; the revision of meaning by managers, lawyers and communication experts.  I am not privy to all the facts.  I am not a clinician or health manager.  But to say that there was no error in the care or treatment provided would seem disingenuous at best.

Clearly, something went wrong.  A baby was sent home with an undiagnosed broken neck.

Assuming the care and treatment provided were without error, then surely the diagnosis was "incomplete", flawed, missed, botched, plain wrong.  (Is that a mistake?  Or an error?)  And if so, since when has diagnosis (accurate or incomplete, as the case may be) been excised from the prevailing concepts of care and treatment?  Isn't diagnosis implicit in care and treatment?  Shouldn't it be?

Policies, procedures and guidelines are proven management tools for effective and efficient businesses.  But they are also reductionist by nature, allowing clever managers to review 'incidents', obfuscate and deflect, and conclude, as in this case, no error was made.  

So maybe it's the execution of all these constituent steps of care and treatment, these policies and procedures, that's the problem.  Maybe the junior doctor (et al.) made a mistake with the care and treatment provided - an error of judgement.

But then, that would surely depend on how you conceptually apply the word.  I guess it's back to The New Oxford Dictionary for me.

Bear Grylls: no room for error.
via http://www.beargrylls.com/

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