Why Do Patients Deteriorate?

Why Do Patients Deteriorate? Dr. Riyad Nasrallah 06/06/2022

1)?????No obvious reason. Despite all the efforts of the healthcare professionals and the use of all available treatments the patient may deteriorate.

2)?????Patient’s factors such as age, weight and co-morbidities.

3)?????The severity of the disease.

4)?????The patient is not taking the disease seriously from the start.

5)?????The doctor is not taking the disease seriously from the start

6)?????Not realising that not all patients with infection present with high temperature

7)?????Not realising that other diseases can cause similar features to the current disease.

8)?????The process that caused the deterioration has nothing to do with the diagnosis.

9)?????Not realising that more than one disease can co-exist at the same time.

10)?Not taking the patient’s particular circumstances and co-morbidities into account in the assessment and management of the patient.

11)?Not realising the potential dangers of rigidly sticking to a particular medical management protocol for all patients.

12)?Inadequate assessment of the patient and not performing the necessary investigations from the start.

13)?False reassurance that the patient is stable when the vital signs are normal. A normal temperature, respiratory rate, oxygen saturation, heart rate and blood pressure could be reassuring to the unwary.

14)?Not having a systematic approach when managing sick patients.

15)?The wrong treatment. Some treatments may do nothing to the disease process and in some cases may do more harm.

16)?Poor quality of the treatment product.

17)?The wrong timing of treatment. The right treatment may have been given at the wrong stage of the disease process.

18)?The wrong dose of the right treatment. The treatment is the right one at the right stage but the dose is inadequate.

19)?The course of treatment is inadequate. The course was not long enough to cause the desired effect.

20)?Not taking into account the potential side effects of the treatment.

21)?The person is in the wrong place of care. The person is at home while he/she should be in hospital. The person is on the ward while he/she should be in a high-dependency unit or intensive care unit.

22)?Not realising that medical interventions at the early stage of the disease process can make a difference between life and death. ?

23)?Not realising that the deterioration may occur rapidly and leads to death.

24)?Not realising that patients on mechanical ventilation usually do worse than patients who are not on mechanical ventilation.

25)?Inadequate monitoring and, therefore, failure to escalate interventions when the patient starts to deteriorate. Medical interventions and treatments that are used in the later stages of the disease process come with their potential problems.

26)?Not realising that the organs in the body are linked together and a deterioration in one organ may lead to multi-organ failure and death.

27)?Inadequate support of other organs when one organ fails.

28)?Inadequate anticipation of potential problems.

29)?Not realising that if the test result is within the normal range that does not necessarily mean it is normal for this particular patient

30)?Not realising that the patient may have the disease despite normal imaging.

31)?Not putting the absolute value in the context of the trend.

32)?Relying on assumptions.

33)?Relying on facts.

34)?Giving up on the patient prior to trying the available treatments.

35)?Not realising that the body will start shutting down in severe illness and the compensatory mechanisms may fail to produce the expected warning signs.

36)?Not realising that a group decision is usually better than an individual one.

37)?Not seeking the opinion of other medical colleagues.

38)?Not realising that appropriate reassurance can make a huge positive difference to the health of patients who are stressed, anxious and scared of the unknown. Appropriate reassurance gives the patient the motivation, determination and the drive to fight the illness.

39)?Not realising that an opinion is just an opinion. Proper scientific research and appropriate clinical trials are needed to make generalisations.

40)??Not realising the importance of considering the guidelines and protocols as well as the patient’s wishes and clinical judgement in the management of patients.?