Evan

also note the surgeon used the word 'clinician' - not doctor. If the surgeon expects a surgeon to get the diagnosis, he would expect the same from an emergency doctor. The reason he uses 'clinician' is (in my opinion) to admit a nurse might miss the diagnosis. Secondly, if the child came directly to ED without seeing the GP you are still expected to find appendicitis. The GP referral should be irrelevant to this root cause analysis, and they are fully responsible for managing their patients completely, not diverting blame.

@EvanDownUnder @DrNeenaJha From what I read it says that the GP documentation was missing - so nobody decided the GP was wrong, or had idea what the GP thought. Also a consultant surgeon opined that not all clinicians would necessarily diagnose appendicitis.

Child with severe abdo pain + fever GP diagnosis ?appendicitis - for urgent A&E r/v Seen by ANP in A&E - misdiagnosed as constipation & sent home. Does NOT escalate to a doctor Child later dies from a perforated appendix 🚨 Doctor replacement with non-drs COSTS LIVES! Enough!

you will see they have omitted what was told to the mother by the GP (I.e. I'm sending your son to emergency because I think he has appendicitis) and what was told to the hospital staff by the mother (I e. the GP sent me here because he thinks it's appendicitis). Then blamed the lack of documentation so they didn't have to blame the system. Either way, in this particular case, the doctor picked it up and the nurse didn't. So saying that 'doctors miss things' is not pertinent to this scenario when the diagnosis had already been obvious to a clinician.

@joshibza yes, sadly the coroner is too scared to tell the truth and address the clear systemic failure

Let us be absolutely clear: the issue here is not the absence of a referral note. While a handwritten letter is a useful tool, fixating on it completely misses the point of clinical accountability. If that patient had lost the referral, would we truly send a distressed child back to the GP to get another copy? Of course not. The moment a patient arrives in the Emergency Department, they are our responsibility regardless of what is written on a piece of paper. The referral is an aide, not a crutch, and it certainly does not replace independent clinical assessment. The real failure occurred when a nurse, operating beyond their competence, failed to clerk the patient, failed to examine them, and dismissed a child in severe painful distress as simply constipated. That is the fundamental error we must address. The question that should have been asked in that moment is painfully obvious: why would a General Practitioner refer a routine case of constipation to an Emergency Department if it could be managed safely in the community? The answer is that they wouldn't. The GP recognised an emergency; the nurse, unfortunately, did not. Let us not make excuses for poor clinical judgment or for placing unqualified individuals in positions of critical responsibility. In Australia, Canada, and the United States, such unsafe practices would not be tolerated. Cheap labour comes with costly consequences misdiagnosis, delayed treatment, and avoidable harm. We cannot use gaps in the rota to justify gaps in competence. Medicine demands that we all work strictly within our scope of training. Do not use qualifications you do not possess to make decisions you are not equipped to make. A referral note may guide you, but it does not replace your own history-taking, physical examination, and sound clinical reasoning. That is the standard we must uphold not just for the sake of process, but for the safety of every patient who walks through our doors. That is non-negotiable.

@drsthanus what about getting their neck blood pressure, Doc ?

The diagnosis that should make you question a non-invasive blood pressure reading of profound hypotension while a radial pulse remains palpable is pseudohypotension secondary to a vascular anomaly or obstruction, most notably subclavian artery stenosis or aortic dissection affecting the subclavian artery branch. ●To determine the patient's true systemic perfusion status, perform the following diagnostic steps: 1. Measure Bilaterally: Immediately cycle the blood pressure cuff on the opposite arm. A discrepancy of (>20mm Hg}between arms strongly confirms a localized vascular issue rather than true shock. 2. Assess Lower Extremities: Take a blood pressure reading on the patient's thigh or calf to confirm central perfusion if both upper extremities are suspected of vascular anomalies. 3. Check Central Pulses: Correlate your findings by palpating central locations, specifically the carotid or femoral arteries, to gauge overall circulatory status.

to make a new reef

@DronusAdelaide @Tesla @TeslaAUNZ @Tesla_AI wow! a pleasant change from reading every 110 sign as 100

I think Tesla need to focus on mapping data. The southern expressway in Adelaide is 100kmh not 130kmh. @Tesla @TeslaAUNZ @Tesla_AI

@MardyMoustache @DrNeenaJha the fact here is that the doctor ALREADY picked it up. And based on the outcome, the nurse decided the GP was wrong

@DrNeenaJha Hmm. So no doctor has ever done this?

@Andywebster @DrNeenaJha @MunchkinDr the system error is replacing doctors with non doctors and a health system that cares more about cost than mortality

@DrNeenaJha @MunchkinDr Yes but it was not just the fault of one individual as always there are system errors. This is a very sad case. But patients are sent home by doctors and get bad outcomes too

@NZ_Tim93 yeah, just test drive and compare.

Model Y test drive tomorrow, stay tuned for more updates 🫠

My Dad just called to tell me he's considering a fucking Toyota BZ42069XV whatever it's called. How's your day going?

@mmuoIX And the coroner is too chicken to tell the truth

As a doctor, once a GP has suspected something in community you have to be extremely sure you've ruled that out before discharge. These practitioners are so bold my god.

@Taths3022 @willfleming navman will make its comeback

@willfleming You can see the nav told it to do that. We need new nav version

Had a bit of a critical moment today with FSD v14 DU where it nearly drove me into the kerb. In the moment, it didn’t feel that bad, but watching it back, it could have gone much worse. I also thought my front camera needed servicing because it wouldn’t read speed signs, but I’ve seen a few people here on X saying they’ve encountered something similar. Basically, FSD v14 DU just isn’t reading speed signs reliably (for me). A new day with new adventures tomorrow…

@willfleming for me V13 consistently reads 110kph signs as 100kph. It misreads them so well.I've come to believe it was deliberate

@harald_murphy @Tesla @TeslaAUNZ @TeslaCharging Can you rate out of ten how much more or less relaxing it is now on the Supercharger network?

AUSYtour FSDStour @Tesla @TeslaAUNZ Model YL Day 6 Arrived Rockhampton Queensland after traveling 229km from Carmila. Efficiency 165Wh/km. Charging at the @TeslaCharging V3 Supercharger.

@ryanjaycowan the wiggle test is what matters to me - if it doesn't shift when you push it around, it's good. The opposite is also true: If it's installed according to spec but still wiggles, it's not safe (personal opinions only)

Model Y L child seat update: For us, the Nuna Rylo works in the captains seat, with rear tether going directly over the top of headrest (as per Tesla manual). Professional installers however won't agree with this and we still dont have an official recommendation from Nuna *yet*. But once fully tightened, the rear tether is impossible to move.

@drkeithsiau I do wonder how many medical accounts are actually bots. I'm interested to find out, but can't believe so many people/bots confuse an endoscopic appearance with a radiological appearance!

Coffee bean appearance seen on colonoscopy. What is this?

@EVStraya @Tesla_AI fantastic

So courteous @Tesla_AI 🫡 👮🏻‍♂️

@alanhoward for sure. I also feel it is best to correct it at every opportunity, to make it the driver I want it to be. Spare the rod, spoil the child

@EvanDownUnder I'm the same. Unlike what lot of others seem to do, I always intervene when it wants to break the law. That feels lot safer than letting it, just so I can complain about it on X. 👀

probably not coming to me because I disengage V13 nearly every drive for a critical intervention.

@simongerman600 oh but you are

Good news. At all ages, death rates have been declining. Even better news: we still die. I for one aren't made for eternal life... Source: reddit.com/r/dataisbeauti…

@Derek_VS_Derek haha, I never thought about the feedback as catharsis!

@EvanDownUnder Same. I probably swear too much on it.

@NeilBoltonRSPL 😋

@EvanDownUnder Everyone does. That's why we're still alive.