To Reduce Risks, Hospitals Enlist ‘Proceduralists’ | WSJ | 7.11.07
Awaiting both kidney and liver transplants last year, Larry Pritchard suffered from fluid build-up so severe it sometimes leaked from the skin on his stomach. The condition required a procedure known as paracentesis to drain the fluid, but at the first hospital where he was treated, he says, emergency-room doctors didn’t even know about the procedure and tried to seal the leaks with medical glue. After switching to Cedars-Sinai Medical Center in Los Angeles, he found something he hadn’t heard of before: a dedicated Procedure Center, where doctors were expert at inserting a needle deep into the abdominal wall to drain fluid.
“The doctor knew exactly where to put that needle, and everyone at the procedure center was a pro at what they were doing,” says the 62-year-old retired attorney. At Cedars-Sinai’s center, experts performed the paracentesis procedure on Mr. Pritchard more than 60 times over six months, as frequently as three times a week, and inserted and removed dialyses catheters before his dual transplant last August. “They literally kept me alive,” he says.
Meanwhile, medical groups are also concluding that the traditional method of training residents — known as “see one, do one, teach one” — is dangerously inadequate.
“I vividly remember thinking I’ve never done this, and it’s almost like a dirty little secret that this patient doesn’t know that,”…”[w]e fumbled our way through it with no issues, but it just highlighted for me what an awful way it was to teach.”
To extend the old ditty:
- See One
- Do One
- Teach One
- Inadequate One
- Dangerous One
I’m shocked, another anecdote from when the giants walked the earth bites the dust…