Question

Case 87

The Case of the Dishonest Employee

Dale Buchbinder

Dr. Jonas was examining a patient in the office who needed a dialysis access procedure performed on one of her arms. Dr. Jones reviewed the vital signs done by Ms. Smith, a med tech/secretary. Her documentation in the medical record clearly stated the blood pressure was equal in both arms. Dr. Jonas performed his own examination and realized that the radial pulse in the left arm felt diminished as compared to the right. After completing a thorough examination, he was still somewhat concerned by the discrepancy between the physical exams and the vital signs placed on the chart by Ms. Smith. He repeated the blood pressures himself. Sure enough, the systolic blood pressure in the left arm was 60 mm/hg less than the right. The patient’s left arm would have been the preferred site to perform an access procedure because the patient was right-handed. Now it was clear only the right arm would be suitable unless another intervention was performed first. If Dr. Jonas had relied on the information placed in the chart he would have conducted an access procedure in the left arm. With a low systolic blood pressure in the left arm, the access would have been doomed to either failure, or given the patient’s physical status, a severe complication such as steal.* Since he was trying to sort through the facts and what happened, Dr. Jonas asked the patient if blood pressure readings were performed in both arms. The patient replied the pressure had only been taken in the right arm. Dr. Jonas confronted his employee and told her that her blood pressures were not correct, and, in fact, the patient had stated that they had not been taken in the left arm. Ms. Smith stated that she was quite busy and felt that these pressures were never different. With her response, she admitted to having falsified the data.

Discussion Questions

1. Summarize the important aspects of this case.

2. Which theory or theories do you believe best explain Ms. Smith’s behaviors?

3. What actions would be appropriate in dealing with such falsification of patient data?

4. Should Ms. Smith be terminated, counseled, or disciplined in some other fashion?

5. What are the clinical implications of Ms. Smith’s actions?

6. What are the legal implications of Ms. Smith’s actions?

7. What should Dr. Jonas do in the future to make sure that this set of events does not recur?

Answer 1

1. It can lead to harm to the patient

-Ms Smith is not doing her duty, as what ever the busy schedule it is any patients vitals to be checked without any error, or else record it was not recorded, it may lead to patient receiving wrong procedures leading to worsening of their condition.

-she is not admitting she has done wrong.

2.Rationalism

justifying one’s actions or feelings with socially acceptable explanations rather than consciously acknowledging one’s true motives or desires

Resistance

unconscious attempts to block the revelation of repressed memories and conflicts

3.-educating staffs of the hazard of falsifying

- legal complication that can occur if patient is complaining

-she should be warned

- she should be not included in such duties.

4 she is should be educated and disciplined

5..-It can go for misdiagnosis

-complications can occur

-interpretation bias

- the other patient also lose hope of this hospital.

6.-false interpretation can lead to felony

- imprisonment

7. - it should be recorded in front of the patient in the case sheet

- flexibility of duties, one person allotted for recording vitals.

- can be recorded under supervision.