Residency programs have annual in-service talks about diagnoses for which there are non-obvious risks with medical interventions that can result in morbidity or mortality.
Example to work through
One such diagnosis is Serotonin Syndrome, which became prominent after the death of 18-year-old Libby Zion, a tragedy that resulted in regulation of doctors’ work hours.
Such education can now be supplemented with contextual warnings about such risks, including references to the literature. In the image below such a risk warning was highlighted by a red asterisk next to serotonin syndrome. Clicking on the asterisk provides the warning about a risk that might be nonobvious, particularly by a clinician who is overworked and sleep-deprived. It is indeed important to have enough sleep and enough to eat when diagnosing a patient, but knowledge of the risks associated with diseases in the differential diagnosis is crucial.
The error associated with failure to focus on such risks is treatment malpractice.
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