On Medical Mistakes…

To err is human, to forgive divine.
Alexander Pope

A recent post, The Dangers of July in the Hospital, addressed medical errors during July, when residents and interns fill their new positions for the first time. A recent article written by Pauline Chen, Talking to Patients After a Medical Error, takes this issue to another level and poses the question: Should physicians admit their mistakes? A program started at the University of Michigan in 2001 which addressed medical errors by discussing them with patients and their families and by offering apologies with compensation. The end result was that the number of claims and lawsuits filed against the hospital decreased between 1995 and 2007. Should such systems be implemented elsewhere?

This is a controversial question. First, from a historical perspective, doctors have long been discouraged from admitting their mistakes. In doing so, they put themselves at risk for criticism and humiliation from their colleagues. The old-fashioned, paternalistic approach to medicine required that the physician maintain an image of professional, intelligent, and even faultless behavior. To admit openly to anything less than this would be considered failure. It would also cause anxiety, place blame, and put the individual and the hospital at risk for law suits. But these are not the only effects: there are benefits too, as demonstrated by the program in Michigan.

The morbidity and mortality conference, often used in surgery and anesthesia, provides a forum where medical errors can be discussed. But this forum is not open to the public and does not allow for internal investigations or discussions with patients and families. At the very least, it serves as a place where physicians can discuss their mistakes – and how to avoid them in the future – with their colleagues. It serves as a starting point for discussions about medical errors, which should be encouraged. It is only by examining our errors that we can work to reduce them.

But medical errors are a touchy subject and with good reason. Here is the harsh reality: doctors are human – and they will make mistakes. Unlike other professionals, however, whose mistakes may cost people’s jobs, money, or reputation, doctors’ mistakes can cost lives. The stakes are much higher (and they are similar to the military in this regard). Although we may be willing to accept the idea that doctors will make mistakes, we may not be so willing to accept doctors’ mistakes when they affect us directly. This becomes very personal.

Many medical errors happen not through the fault of one person but through a series of failures. For example, a patient is administered the incorrect dosage of a medication. This may be because the nurse is a little more tired than usual at the end of her shift and does not triple check the label on the bag that comes up from pharmacy; the physician is a new intern who may not know how to use the computer order system and inadvertently orders the wrong dosage; the computer system usually has an error message that pops up but somehow this error message does not go through; the pharmacist who normally checks these orders is out on sick leave. As a result of all these failures, the patient gets the wrong medication. In some situations, it is easier to place blame on a single person.

But in either case, a mistake is made. If there is an adverse outcome, how is this best handled? Families deserve to know about medical errors. And most physicians want to be up front with patients – even if only to free themselves of the heavy burden of guilt. Should fear of litigation prevent this process from occurring? Fortunately, the new research gives us a very encouraging answer: no. The success of the program at the University of Michigan should demonstrate to physicians and patients alike that not only do they deserve to be informed of medical errors, but they are also less likely to sue if they are informed. This information should not only encourage physicians to admit their mistakes but should also restore some of the faith we have in humanity – in spite of the easy access we have to lawyers, and in spite of the relatively large amount of lawsuits in this country, when our own and our families’ health are on the line – one of the most frightening, ground-shaking realities – and when, in the face of this, we are confronted with an honest confession and an apology, we are less inclined to sue – and more inclined to forgive. This new program should provide enough evidence that physicians should be honest with their patients and should be more open about medical errors, in the hopes of minimizing them.

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4 Responses to On Medical Mistakes…

  1. Michelle W says:

    I dropped by from Grand Rounds and was struck by the paragraph you offered about how the mistakes in medicine are more personal. I think you’ve hit on an issue that few acknowledge in this conversation, that emotions are heightened because unlike in a lot of careers, a mistake may mean death, or life-long handicap. It’s hard for any of us, when faced with such a personal crisis, to think straight.

    I’ve seen some compare this to pilots who crash: however, pilots who crash rarely survive. When the Titanic sank, the captain went down as well. These are errors people forgive posthumously because the “perpetrator” suffered as well. Engineers or designers make mistakes sometimes that can cause lives, but they’re rarely public figures who are easy to see as responsible (look at the recent oil crisis in the Gulf to see where more people targeted their wrath). Doctors are in a unique position of being both the public figure and the engineering one, someone who has to both deal with people and science. That too may be another facet of the malpractice issue.

  2. Pingback: Grand Rounds Vol. 6 No. 49 – a conference in a tropical island resort | A Blog Around The Clock

  3. What I have personally noticed is that when mistakes occur, if you discuss them openly with the patient and his or her relatives and are genuinely sorry, most patients and families tend to be very understanding and do not pursue further action.

    On the other hand, hiding facts and refusal to admit a mistake, especially when it is obvious would probably bring out the worst in patients – possibly because they totally loose trust in their doctor.

    One of the consultants (senior doctor) I worked under made an error while treating a patient, but was very open and honest about it. Not only did the patient not mind, he even brought several more patients to be treated by us !

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