March 26, 2015
Late last year, the Institute, in conjunction with Do No Harm Project, put out a call for medical trainees to write vignettes, or essays, chronicling harm or near harm resulting from medical overuse. After a review process by a team of judges, two vignettes were chosen as awardees of the Do No Harm Project Competition, from the 34 essays that were submitted from around the nation. Stephanie Chen, MD, from Johns Hopkins, Bayview Medical Center, was one of the recipients, and had her essay published this month in JAMA Internal Medicine’s Teachable Moments section.
Her essay, titled Behind the Monitor—The Trouble with Telemetry, describes the case of an elderly man with dementia, admitted to the hospital after a fall and in his evaluation, was found to have stable atrial fibrillation that led to telemetry monitoring. As the patient pulled at his leads, alarms sounded and sedative medication was given to him, resulting in delirium. Chen’s case underscores that clinicians should use telemetry appropriately, even as they search for more data.
With co-author, Sammy Zakaria, MD, MPH, Chen writes “Overuse of telemetry has unintended consequences that we ought to be cognizant of in order to weigh the clinical benefits and potential harms for our patients.”
The second vignette awarded was from Spyridoula Maraka, MD, with secondary authors Derek O’Keeffe, MD and Victor Montori, MD, from the Mayo Clinic. Their essay recounts the case of a woman who suffered ill effects in the course of being treated for subclinical hypothyroidism in pregnancy. She was started on thyroid replacement medication and palpitations set in, ultimately leading to an ER visit. The case demonstrates harms that can occur with low thresholds for disease labeling and the treatments that ensue.
Both vignettes were presented by the authors at the annual conference.
The project, jointly sponsored by the Institute and the Do No Harm Project, is supported by the Robert Wood Johnson Foundation. It was developed at the University of Colorado School of Medicine by Tanner Caverly, MD, MPH and Brandon Combs, MD, an Institute Fellow.