Psychology of Learning and Memory

Essay

Read the following scenario and answer the essay question:

"Critically evaluate how the cognitive processes of perception, attention, and working memory can help to explain why Dr McNulty failed in her duty of care to Mr Koen"

Case Scenario

Dr McNulty is a doctor with many years of experience in acute medicine helping patients with a wide range of medical emergencies. She has an excellent track record in caring for patients with complex needs in the stressful environment of a busy hospital. She recently moved to a new city to work in a new hospital after an extended period of bereavement leave following the sudden death of her daughter in a skiing accident. Since the accident, Dr McNulty had been quite depressed and had not been sleeping well. She hoped that the fresh start would help her to move forward. Unfortunately, her first day back at work was disastrous. The decisions taken by Dr McNulty contributed to the death of a patient who would otherwise have survived.

On Dr McNulty's first day at her new job, she realised that the hospital was understaffed. Her supervisor was away on a training course, so she was put in charge. She was also asked to cover the work of another doctor who was absent. She was responsible for the care of more patients than she could comfortably manage. The only other doctors available were junior doctors that needed Dr McNulty's support. Apprehensive, Dr McNulty started her 10-hour shift trying to care for her patients the best she could.

Dr McNulty was given a pager so that she could be alerted to issues or emergencies. Dr McNulty rushed between the different floors of the hospital responding to emergencies, switching between wards and supporting the junior doctors. She had no time for food, drink or a break.

One of Dr McNulty's patients, Mr Kane (aged 78), was in the hospital because of a serious infection (sepsis). Mr Kane had a "Do Not Resuscitate" order. He had spent the last 10 years battling a prolonged and painful terminal illness. There was no chance for him to recover and lead a good quality of life. Last year, he suffered a cardiac arrest (heart attack) and was resuscitated. Since then, his health had deteriorated significantly. Mr Kane, his family and his doctors had agreed that if he had another cardiac arrest then he should not be resuscitated and instead should be allowed to die. His friends and family hoped he would recover from the infection and be well enough to go home, but there was no hope for his long-term prognosis.

Another patient, Mr Koen (aged 87), was also in the hospital because of a life-threatening infection. However, Mr Koen was otherwise healthy. He was active in the community. He volunteered at his local food bank. He recently won 3rd place in a Seniors Dance competition. His friends and family hoped that he would soon be back to his old self. Mr Koen was receiving the same treatment for his infection as Mr Kane.

The hospital was having IT issues that day. Usually, Dr McNulty would read her patient's test results on a computer screen. On the computer, unusual results are highlighted in red, so it was easy to see when a patient was deteriorating. Because of the IT disruption, she could only get test results over the phone. A lab technician would read out a list of results while Dr McNulty quickly jotted them on a notepad.

Six hours into her busy shift, Dr McNulty received the latest lab test results for Mr Koen. She jotted the results on her notepad and compared these with his previous lab test results. She also looked at the nurse's observations and Mr Koen's chest x-ray. With all this information, Dr McNulty assessed that Mr Koen was showing signs of improvement. She saw that his lab results had improved slightly, and his temperature had improved. At this time, she could have made the decision to increase Mr Koen's treatment, but she decided that this wasn't necessary. She thought that he would soon pull though. Unfortunately, Dr McNulty had not noticed that some of Mr Koen's test results were actually getting worse and were cause for concern.

Seven hours into her shift, more patients were admitted by ambulance. The ward became increasingly noisy and busy. The nurses needed to move the patients around to make room for more beds and specialised equipment. Mr Koen was moved to the area (Bay 12) where Mr Kane was previously being treated.

Nine hours into Dr McNulty's shift, her pager beeped and she received an announcement that Mr Koen, in Bay 12, had gone into cardiac arrest and a resuscitation team was called. Remembering the "Do Not Resuscitate" order, Dr McNulty rushed to Bay 12 to tell the team to stop resuscitating the patient, because they would be in violation of a "Do Not Resuscitate" order. It was only later, after Mr Koen had passed away, that she realised that she had confused Mr Koen with Mr Kane. Mr Koen did not have a "Do Not Resuscitate" order.

In a review of the incident, the hospital decided that Dr McNulty was negligent in her care of Mr Koen. She should have noticed that Mr Koen was deteriorating and provided stronger treatment for him hours before his fatal cardiac arrest. She was also negligent when she prevented him from being resuscitated. Dr McNulty was referred to a disciplinary panel.