Language is Safety: “The Resident Ordered It”
When a verbal order has no author, accountability disappears. And in obstetrics, disappeared accountability has consequences that no deposition can undo.
Labor and delivery. ObGyn. They save lives every day. They also harm patients in ways that are preventable, traceable, and fixable, if you know where to look. This series shows you exactly where to look, and by the time you finish it, you will be a more informed clinician, a more empowered patient, and a more effective advocate for the care that every woman deserves.
The Case That Followed
The case I described in Episode 2 was not the last time oxytocin and ambiguous language combined to produce a preventable harm on that unit. The second case was different in its details and identical in its mechanism.
A patient was admitted for induction. The attending arrived, assessed her, and told the chief resident to start oxytocin. He then left the floor. Not for surgery this time. Simply gone, in the way attendings sometimes are when a case feels routine and a capable resident is present.
Over the next several hours the clinical picture changed. The oxytocin continued. The fetal heart rate tracing deteriorated in the way tracings do when nobody with authority has made a decision to stop. By the time the attending was back, the situation had become an emergency.
What followed the delivery was a legal proceeding. And in that proceeding something remarkable happened, remarkable but not surprising to anyone who has watched these cases unfold.
The attending said the resident had ordered the oxytocin.
The resident said the attending had directed him to order it.
Both statements were true. And because both statements were true, and because there was no document that said otherwise, the question of who had made the clinical decision, who had assessed this patient and determined that oxytocin was indicated at that dose at that time, became genuinely unanswerable in a court of law.
A verbal order has no author. That is not a legal technicality. It is a patient safety crisis waiting for a clinical situation to reveal it.
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