Review Question - QID 216644

All concerns about patient care including those from junior team members should be taken seriously in order to protect patients. In accordance with this principle, the proper response by the resident is "we should review the imaging to verify that this is the correct side."

Many team members are often involved in the care of a single patient in the practice of academic medicine. These may range from very junior members such as 3rd-year medical students to very senior members such as attending physicians. Often, junior members of the team may have questions and concerns that are derived from their lack of experience. If these items would not impact patient safety, they can be safely addressed at a later time if there are urgent clinical responsibilities; however, patient safety concerns should never be ignored.

Incorrect Answers:
Answer 1: "Are we sure that we have the correct patient for this case?" is an important thing to verify during a surgical time-out; however, it is minimally relevant to the concern raised by the student in this case because almost all patients will have a right-sided appendix. Additionally, the patient identity has already been confirmed during the surgical timeout. This would be more important for surgeries such as joint replacement where different patients may have different sides done in the same day.

Answer 2: "I can explain to the anatomy of this case to the medical student after the case" is a generous offer from the resident, and providing teaching is an important part of the role of a resident; however, the patient safety concern raised in this case should be addressed first.

Answer 3: "I told the medical student to review the anatomy of appendicitis before this case." is not an effective method of promoting learning by the student and dismisses their patient safety concern without addressing it.

Answer 4: "The appendix is located in the right-sided ascending colon so we are doing the case on the right" is true of almost all patients; however, the patient's anatomy should be verified from pre-operative imaging to rule out cases of situs inversus given the student's patient safety concern.

Bullet Summary:
All patient safety concerns should be taken seriously even if they are raised by the most junior members of the team.