0:04
last year we had a very significant very

0:06
sad case involving a young man who

0:09
walked into the hospital with what was

0:13
clearly concerning symptoms related to

0:16
swelling in his brain for the longest

0:18
time as we looked at the case we could

0:20
not figure out why nobody responded

0:23
until we got the cell phone records of

0:27
the residents who were overseeing his

0:28
care as is so often the case in

0:31
hospitals there’s one story that is in

0:33
the official record and there’s another

0:35
story of what’s actually happening to

0:36
the patient and what we saw in those

0:38
residences were residents who were not

0:41
given proper guidance who were kind of

0:43
left to flounder on their own and were

0:45
making mistakes and nobody was

0:47
responding to them and nobody was

0:49
helping them understand what our patient

0:50
what our client needed and the result

0:52
was catastrophic that our client didn’t

0:54
get the care he needed he ended up with

0:57
a very bad brain injury in that case we

0:59
have these kind of parallel records we

1:01
had the official record and then we had

1:03
all the text messages between the

1:05
residents and that created a kind of a

1:07
secondary sub record of what was really

1:09
going on

1:10
and it’s a very dangerous practice

1:12
because basically what was happening was

1:15
everybody under 40 was caring for this

1:17
guy on text messaging and everybody over

1:20
40 was looking at the at the medical

1:22
record well the people who are over 40

1:25
of the people who actually knew what was

1:27
going on the people under 40 didn’t but

1:29
because the people under 40 have been

1:31
given cell phones have been told to use

1:33
them

1:33
they weren’t communicating in a way that

1:36
the people who were over 40 more

1:37
experienced could have seen and

1:39
evaluated so they had the more senior

1:42
Physicians were not looking at what the

1:44
junior Physicians were doing one of the

1:46
things that we’ve I find you know

1:49
both interesting and very frustrating

1:51
about doing Hospital cases is

1:53
recognizing how hierarchical hospitals

1:57
are in part that’s necessary you know

2:01
the the star surgeon talks down to the

2:04
hospitals the hospitalist talks down to

2:06
the nurse the nurse talks down to the

2:09
nurse’s assistant and this is clear

2:10
chain command the problem is that when

2:14
things go wrong that chain of command

2:16
means that people don’t know how to

2:18
evaluate themselves you know the surgeon

2:21
will always deny responsibility he will

2:23
always blame the hospitalists the

2:25
hospitalists will always denying

2:26
responsibility and they will always

2:28
blame the nurse and so some of the value

2:30
that we add as medical malpractice

2:32
professionals is we don’t respect that

2:34
hierarchy we’re not part of that

2:36
hierarchy we can scrutinize anybody’s

2:38
Behavior up and down the chain and that

2:40
allows us to examine and get better

2:44
understanding of what happened to our

2:45
patients often than the treaters in the

2:47
hospital themselves