Stephanie P. Pezzo

Physician Evaluation after Medical Errors: Does Having a Computer Decision Aid Help or Hurt in Hindsight?

Objective. The authors examined whether physicians’ use of computerized decision aids affects patient satisfaction and/or blame for medical outcomes. Method. Experiment 1: Fiftynine undergraduates read about a doctor who made either a correct or incorrect diagnosis and either used a decision aid or did not. All rated the quality of the doctors decision and the likelihood of recommending the doctor. Those receiving a negative outcome also rated negligence and likelihood of suing. Experiment 2: One hundred sixty-six medical students and 154 undergraduates read negative-outcome scenarios in which a doctor either agreed with the aid, heeded the aid against his own opinion, defied the aid in favor of his own opinion, or did not use a decision aid. Subjects rated doctor fault and competence and the appropriateness of using decision aids in medicine. Medical students made judgments for themselves and for a layperson. Results. Experiment 1: Using a decision aid caused a positive outcome to be rated less positively and a negative outcome to be rated less negatively. Experiment 2: Agreeing with or heeding the aid was associated with reduced fault, whereas defying the aid was associated with roughly the same fault as not using one at all. Medical students were less harsh than undergraduates but accurately predicted undergraduates responses. Conclusion. Agreeing with or heeding a decision aid, but not defying it, may reduce liability after an error. However, using an aid may reduce favorability after a positive outcome.

Palla’s Sign and Hampton’s Hump in Pulmonary Embolism

A 37-year-old female with lupus anticoagulant developed severe hypoxia during dilation and curettage for spontaneous abortion. A chest radiograph (panel A) showed a wedge-shaped peripheral opacity (Hampton’s hump [1] , long arrow) as well as a prominent right descending pulmonary artery with a sharp cutoff (Palla’s sign [2] , short arrow). Subsequently, a CT angiogram (panel B) demonstrated massive pulmonary embolism in the right main pulmonary artery extending to the upper, middle, and lower lobe branches with features suggesting subacute or chronic thrombus. Bilateral pulmonary arteries were enlarged, indicative of pulmonary hypertension. A peripheral opacity was seen in the right middle lobe consistent with pulmonary infarct. A recent analysis of CT angiography in patients with massive pulmonary embolism found that 76% had pulmonary artery dilation, and 36% had wedge-shaped pleural-based consolidation [3] . Despite the common occurrence of these findings on CT, the concurrence of both Palla’s sign and Hampton’s hump on chest radiograph has not yet been reported to our knowledge.