Tuesday, April 28, 2009


This morning I am up at the crack of dawn for the monthly quality assurance meeting. It is my favorite meeting of the month and I am not being facetious. I have been doing this for, let me see, almost sixteen years! There is more painless learning in this one hour than any other time of the month. The only time that it is painful is if one of my cases is being presented.

The physicians that serve on this committee receive no monetary compensation for what amounts to about six hours of work each month. The reward for serving on this committee is that a lot like medical school and residency, you find out what will get you in trouble second hand.

It works like this:

The hospital has a list of "quality indicators." Things such as excessive blood loss at a delivery or a surgery, the patient developing a complication, the baby developing a complication and so on. I believe you get the picture.

Now these things happen. And interestingly enough it is usually not the "quality indicator" that got the patient in trouble since everyone is doing everything they can to keep these things from happening.

No, what gets patients and ultimately doctors in trouble is some little, seemingly insignificant occurrence that no one noticed. Here too is the pay off for those of us on the committee.

I will give you an example. Early in my stint on this committee there was a Cesarean section patient who developed a fever. She received the correct antibiotic at delivery to protect her from infection. The doctor involved saw her when she developed the initial temperature spike and every spike after that for four days and then her appendix ruptured. She got peritonitis, an inflammation of the lining of the abdomen and had to undergo another surgery. This is when the appendicitis was diagnosed.

Now the chance of appendicitis after a C-section is probably less than one in a thousand patients but this whole thing happened to a very good physician that I respect a great deal. It also happens that I don't ever do a C-section without at least a glance at the appendix to make sure that it looks alright.

Every meeting is like that. Some great pearl of a pay off for those hours looking at charts, getting up early, wrestling with the issue of how to make the quality of medical care better for future patients.
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