Mitigating perceptual error with 'look, listen, feel'

摘要

One student has argued for'always palpate the pulse' after using it to discover an undiagnosed arrhythmia (Dickinson, 2015). I had done the same, only with finding the rhythm on the pulse oximeter display, after developing a habit of checking to assess signal reliability (helping to avoid misreading the results of motion artefacts). Was I wrong not to be swayed to routine manual palpation? Had years of unchallenged practice tainted me with confirmation bias? I had, however, researched and applied an evidence-based approach, using my clinical judgement. My experience was that it worked. Until one time when it did not. I deferred for a year and, frankly, got a bit rusty. I lost the habit of checking rhythm on the pulse oximeter display, not noticing I was missing a critical skill, right up to when I reported a tachycardia to a nurse and she wisely asked me to confirm it by taking a manual radial pulse. On trying to count the rate, it was apparent how erratic it was and in that awkward moment I learned why-manual palpation is so important: because it was foolproof. The arrhythmia was literally unmissable. Remembering my reading, I looked and there it was too, on the pulse oximeter display.