Sleepy interns and journalists

October 28, 2004 -- Today news outlets carried stories about findings that physician interns working the standard 24-hour shifts made one third more errors than those working 16-hour shifts, according to an important new study of cardiac and medical ICU's at a Harvard-affiliated hospital. The stories carried by three major national news organizations--the Associated Press, Reuters, and The Washington Post--illustrate the wide range of treatment nursing can receive from the elite press as to what is essentially the same story, apparently depending on the journalists involved.

Janet McConnaughy's AP piece about the study, which was published today in the New England Journal of Medicine, was clearly the best for nursing. Not coincidentally, the AP story was also one of the best in general, with good context, telling detail and a mix of quotes, including several from an intern who was a subject of the study. The article carefully notes that, despite all the errors--some critical--"[t]here was no difference in the number of patient deaths and the average length of hospital stays, largely because other staffers often found and corrected the mistakes, researchers said." The piece doesn't stop there, but explains: "Nurses noticed when one intern ordered 10 times the correct dose of a drug to raise blood pressure, and when another miscalculated a patient's fluid intake and missed symptoms of fluid retention." Of course, nurses can't catch all physician errors--any more than physicians could catch all nurse errors--and the piece also reports that a tranquilizer overdose was not noticed until it caused dangerously poor vital signs, and that one patient's lung collapsed when a tube being inserted into an artery punched a hole in the space around the lung. In fairness, the piece might have noted that nurses are not the only ones who catch intern errors; however, it could have also benefited from at least one quote from a nursing expert, since protecting patients from physician and other errors is a critical part of what hospital nurses do.

Gene Emery's Reuters story about the study was fairly short, but it did least manage to note that "[m]ost of the intern errors were caught by nurses, pharmacists, and senior members of the medical staff before permanent harm was done." This statement has the added benefit of putting nurses in the same category as highly respected health professionals in providing life-saving care. Of course, the piece would have benefited from some specifics as to the kinds of things nurses are capable of doing to protect their patients, and from some expert nurse commentary on the issue.

Rob Stein's piece in the Washington Post was very disappointing for nursing. It was the longest of the three pieces, and it did a fairly good job of providing context and a mix of good quotes, including several from a public health leader who described the study as "the smoking gun." However, despite its length, the piece never mentioned nursing, and--far worse--had only this to say about why the intern errors did not cause more harm: "There was no significant difference in the number of patients who died, but that may have been largely because a special panel of doctors was monitoring the interns and caught many of the errors." That would appear to be misstatement of what the researchers reported, as both the AP and Reuters specifically noted that other staffers--not study personnel--caught the errors, with the AP story specifically attributing this information to what the "researchers said." But the Post suggested that the errors were caught by the physicians conducting the study, as opposed to the nurses and other professionals who really caught them, and catch them every day in hospitals nationwide, where there is no "special panel." Obviously, this journalistic error is very damaging to the public's understanding of nursing. And though we were able to catch it, we do not reach quite as many lay people as the Post, whose hard copy circulation alone is reportedly over 700,000 for a weekday.