Ramping Up to the AALNC Annual Forum: An Interview with Dr. Stephen Cohen
The AALNC Annual Forum, taking place from April 28-30 in Orlando, Florida, is a vital opportunity for LNCs to increase their knowledge and skills in a variety of subject areas concerning the roles and functions of a legal nurse consultant.
This year’s event will feature a general session led by Stephen M. Cohen, MD, MBA, FACS, FASCRS. Dr. Cohen is a board-certified surgeon, who practices general, colon and rectal surgery, and will be speaking on heuristics and medical malpractice.
AALNC: Can you provide an overview of what heuristics is and where it can show up in a clinical setting?
Dr. Cohen: Heuristics really are mental shortcuts our brains make to come to a quick conclusion. As you know, physicians, nurse practitioners, and nurses are inundated every day with multiple facts of information about a particular patient. Whether this is a patient that I've been taking care of for four or five days, whether this is a new patient I’m seeing for the first time with abdominal pain, I have to make a quicker decision based on what they tell me. Many times, that information is very limited. I have two- day history and a couple of symptoms I have to put together. Using my previous experience, using my training, using other things that are that are embedded in what I've done, I come up with a conclusion.
Are we right all the time? Most of the time, we can get it right. But this is where the medical legal aspect comes in, because many times there's a change in clinical status, or we put too much weight on a particular sign or symptom or objective data, which may have nothing to do with the way the patients present. In the medical legal world, when I'm reviewing, whether for the plaintiff or the defense, it's looking at a case and trying to put yourself in the position of the provider to see what they saw, and how they made that conclusion. If you get down the wrong path, that's where mistake and medical legal issues come in, which can lead to a catastrophe.
AALNC: Can you explain how heuristics apply to medical malpractice?
Dr. Cohen: In essence, what you're going to learn from this particular discussion is I've been involved in many cases, where either there was a very bad outcome, loss of life or limb, or some other disaster that was preventable, I'm going to explain using a couple of real time cases demonstrating how a patient presents and how the initial assessment is not correct. Of course, this is nobody's fault. It looks like it's a pneumonia, the signs and symptoms look like a pneumonia. The patient also had symptoms of a bowel obstruction. Yet somebody writes in the chart, we're treating pneumonia. Well, three days goes by and every new provider, every new nurse, every new doctor kept writing in the chart, this is the diagnosis. There, you know, the lung issue got better, everything else didn't get better. Nobody picked up the other cues, assuming that the diagnosis was already made. That's called anchoring.
One of the heuristic models that gets all of us in trouble is anchoring, meaning you make a diagnosis, and that's what the answer is the rest of the time the patient is being treated. That's where people get into trouble of missing something, because the way you think initially may not be what it is. That's why we come up with something called a differential diagnosis. Differential diagnosis is a list of four or five things that it may be, and we start to narrow them down to rule things out. Of course, we look at the most life threatening one first: you rule out the heart attack; you rule out the stroke. You keep in mind other things can cause similar signs and symptoms; that’s where the heuristics model comes into play.
AALNC: What about heuristics will help an LNC solve a case they are working on?
Dr. Cohen: You have to remember, and we're going to talk a lot about this in my session, outcome is irrelevant in standard of care. We look at a case, and when you're looking at a case going forward, you have to put yourself in the place of the provider, either the nurse or the physician, looking at the signs and symptoms, and if there's a change in clinical status, what should have been done, what could have been done to lead them to the right diagnosis. There are other types of heuristics that come into play based on previous experiences, but you have to ignore that. What is the differential? How did you rule it out? How do you come up with an answer?
AALNC: What are attendees going to learn or take away from your session and how will it apply to their work?
Dr. Cohen: Throughout the session I'm going to talk about cases from both the plaintiff and the defense side, because I've also been asked to defend cases. When a plaintiff attorney looks at a case, they'll take a few data points to try to make their case and work backwards. We don't go backwards. When we take care of a patient, I can only take care of them today and work them up according to how they progress the next four days. I don't have the luxury of hindsight bias or looking at what happened previously.
Many times I'm asked to review cases. Attorneys will take a dead patient, and they’ll use a few data points to make a case to blame somebody. It's important not to look backwards and not to use hindsight bias. Look at a case from the beginning. What was the differential? What was the thought process? It will really help to see it from both sides, not just the plaintiff side, but from a defense side as well. As a Legal Nurse Consultant you have more medical knowledge than the attorneys do. You need to guide them.
AALNC: What are you most looking forward to regarding this year’s event?
Dr. Cohen: Definitely getting back together in person. I love Legal Nurse Consultant talks, because they are a lot smarter than the doctors I talk to, and they ask great questions. I'm looking forward to being in person.
Plan to attend Dr. Cohen’s session titled, Heuristics and Medical Malpractice: The Importance of an Alternative Diagnosis, on Saturday, April 30th from 11:15 AM to 12:15PM EST. Register for the Annual Forum today and be sure to view the full event schedule.