Gennadiy Bakis

I mean this with every fiber of my being: we live in a very different world today than we did 1 week ago. Nothing will ever be the same

A healthy 50 year old comes to the ER with a fever. She doesn’t appear well. A CT scan that’s reported at midnight suggests an obstructed kidney stone. An antibiotic is started fluids are administered. The next morning ID sees her, she’s lethargic, antibiotics are added, she’s moved to the ICU, urology is called. She heads to the OR at noon. Subsequently has a PEA arrest , has a stroke, and dies weeks later. Tragic. Every single adverse event like this reveals a multistage of steps that may have changed the outcome. Broader spectrum antibiotics , more fluids, an ICU admit from the outset. Calling urology at midnight vs 8am. But the key word is may. There’s this dumb analogy to aviation that’s made all the time about never events. As if every adverse medical event is a preventable one. Truly sick patients are like planes that are in a terminal descent. Some portion of the time the pilots can sort it out , mange the problem by fixing something gone wrong, or landing in the Hudson. Every mishap that happens in the airline industry also always reveals a number of choices that would have lead to a much better outcome. It’s easier to derive cause because we are dealing with machines. The pilot was flying at the wrong altitude. A collision would not have occurred if they had not ascended.. in human biology we are left to guess what may have happened if the infected kidney stone had been removed at 2am instead of noon. The earlier the better of course, but an experienced physician is all too familiar with the difficult of managing the inflammatory cascade in the setting of severe sepsis. And yet despite the true difficulty with finding fault in these cases, the system focuses on the finding of fault among every member of the chain that came into contact with this 50 year old. Well not every member , only the members of the chain that have malpractice insurance. The nurse that hung the antibiotics late. No fault individually there.. because there’s no money worth going after. Physicians mandated to carry at least a million dollars of med mal, yes. The hospital , of course. And so we have an ecosystem that exists to find fault. Experts are easy to find that will say without a doubt decision X would have lead to a different outcome. And look, I’m not trying to defend why exactly urology isn’t called at midnight for a septic 50 year old.. I wish that had happened.. I just don’t know if anyone can really say it would have made a difference (on average yes, but for this patient?) . And it actually is a good judgement call in this case to order a ct in a patient with a fever and a dirty urine — most of the time unless there’s something on history/exam .. ur finding this out the the next day when the patient is getting worse/not responding to standard treatment of urosepsis. Should we be ordering a ct abd on every patient presenting with urosepsis? It’s complicated… and our fault tort system isn’t a great way of adjudicating all this. But $$ talk, and while the AMA think they are doing gods work , other health care parties are unified and busy making sure the system set up rewards them handsomely.

Thieves watch people withdraw cash from banks and ATMs and then follow them to steal their money. This crime is called bank jugging, and it can happen to anyone. Criminals will wait for the right moment to strike. They follow their victims after they leave banks or ATMs to another location, then break into the victim’s car to steal their money. Stay safe by following these steps: -Be aware of your surroundings when approaching or when leaving a bank or ATM -Keep any cash you withdraw out of sight -Never leave valuables, including cash, in your car -If you think you are being followed, call 911 or drive to a police station Criminals rely on people letting their guard down. Stay alert and protect yourself from bank jugging.

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