A healthy level of paranoia avoids missed injuries

So what can you do to avoid this potential problem? Here are some tips:

• Admit that it can really happen to you.
• Adopt a firm definition of “delayed diagnosis.”
• Implement a tertiary survey process. This is a complete physical re-examination followed by a review of all diagnostic studies (lab and radiology) that have been performed.
• Be paranoid. I hate the phrase, “maintain a high index of suspicion” because it’s meaningless. It’s like those stupid “start seeing motorcycles” bumper stickers. You can’t see what you can’t see. But you can be suspicious all the time, constantly looking for the inevitable clinical surprises of trauma care.