Excuuuse Me: Medical Errors and Apologies
"It takes a great deal of character strength to apologize quickly out of one's heart... A person must possess himself and have a deep sense of security in fundamental principles and values in order to genuinely apologize."
Stephen R. Covey
"It is a good rule in life never to apologize. The right sort of people do not want apologies and the wrong sort take mean advantage of them."
P.G. Wodehouse
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I want your opinion: Should I apologize to you if I make a medical error? I know your immediate response: "Duh...yes." But try to suspend judgment for a minute as you consider the following (fictional) scenario:
It's the middle of flu season and they are swinging from the rafters in my waiting room. I see your 8-year-old, Petunia, who, like every other kid on the planet, has fever, chills and feels awful. I examine her carefully but can't find a source for the fever. I inform you she has the flu. Drink a lot of fluids, manage the fever, etc... It's the 7th time that day I have made this diagnosis and given this advice.
Except that two days later Petunia is much worse. Now she is "breathing hard" and appears more lethargic. I send her to the ER for an x-ray, which shows a large pneumonia. She does not have the flu.
Petunia is admitted to the hospital and given intravenous antibiotics and supplemental oxygen. I come in to see her after work. She smiles gamely at me but looks terrible. Likely she had pneumonia when I initially saw her. I'm heartsick. But you don't seem to be mad at me, just real worried.
My question to you is: should I admit to you that I probably missed the correct diagnosis two days ago and apologize for the delay in appropriate treatment?
For me, the answer is not straightforward. Here's what I'm thinking:
In my home state, a state senator has just introduced a bill called the "Health Apology Pilot Program". If passed, it would make prompt apologies and admissions of guilt about medical errors inadmissible evidence during a malpractice trial. (Four states - Washington, Colorado, Connecticut and Arizona - already have this type of law on the books.)
As you might guess, this initiative is strongly opposed by the state trial lawyers. They argue that doctors should not be treated differently than anyone else when it comes to legal culpability. Otherwise, a physician could admit his guilt to a family and still be found innocent in court and that's not fair.
And, as you might guess, I'd like to see this law enacted so that, without worrying about lawsuits, I can always choose to be honest with you, to admit my errors, and apologize if I have screwed up.
So, if you were a Massachusetts state senator (not the happiest of fates), how would you vote?
To read more about this debate, see "Doctors Say They Need Protection to Apologize" in the Boston Globe.
To see what else I've written about screwing up, see my blog entry, "Medical Mistakes: Second-Guessing Myself."
Related Topics: Technorati Tags: medical errors, malpractice, apologies, medical mistakes, health and wellness
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For me, the answer is not straightforward. Here's what I'm thinking:
Poor kid... Should I have recognized the pneumonia two days ago? Did I somehow blow it?... I feel awful. I love this kid... I hope I don't get sued... I should apologize. It's the right thing to do... Honesty is the best policy and I've recently been taught that being open about medical errors decreases the likelihood of being sued.But here's what my lawyer is saying:
What are you, nuts? Zip it!... If you apologize, you are admitting to medical error. Should you ever be sued, your apology will be used in a court of law to fry your butt... Who knows if anyone could have picked up on the pneumonia in its early stages... You'll lose your case when you could have have won. You'll ruin your career and your life unnecessarily... Silence is golden.If you were me, how would you handle this excruciating dilemma? Should I follow my heart and apologize to you or should I follow my head and keep quiet, wisely covering my backside?
* * * *
In my home state, a state senator has just introduced a bill called the "Health Apology Pilot Program". If passed, it would make prompt apologies and admissions of guilt about medical errors inadmissible evidence during a malpractice trial. (Four states - Washington, Colorado, Connecticut and Arizona - already have this type of law on the books.)
As you might guess, this initiative is strongly opposed by the state trial lawyers. They argue that doctors should not be treated differently than anyone else when it comes to legal culpability. Otherwise, a physician could admit his guilt to a family and still be found innocent in court and that's not fair.
And, as you might guess, I'd like to see this law enacted so that, without worrying about lawsuits, I can always choose to be honest with you, to admit my errors, and apologize if I have screwed up.
So, if you were a Massachusetts state senator (not the happiest of fates), how would you vote?
* * * *
To read more about this debate, see "Doctors Say They Need Protection to Apologize" in the Boston Globe.
To see what else I've written about screwing up, see my blog entry, "Medical Mistakes: Second-Guessing Myself."
Related Topics: Technorati Tags: medical errors, malpractice, apologies, medical mistakes, health and wellness
14 Comments:
I would vote in favor of enacting a law allowing doctors to apologize without fear of lawsuits. But in all honesty, I don't think it would encourage doctors to apologize.
Here's a real scenario that happened 25 years ago:
Mom noticed that her newborn son occasionally had minor seizures that affected only one side of his body and brought it up with the family's pediatrician. He told her she was an overly concerned first-time mother (this was her third child) and it was nothing to worry about. Several days later, the baby suffered multiple cerebral hemorrhages adjacent to his brain stem and died after being airlifted to UMass.
A few weeks later, Mom and her two toddlers were back at the pediatrician's office for a regularly scheduled appointment. The doctor asked Mom why she hadn't brought the baby in for his 8-week checkup. She replied that he had died two weeks prior. The doctor left the room without saying another word. In his absence, the nurse scolded my mother for making the doctor cry. We found another pediatrician.
(Feel free to contact me via e-mail for dates and details.)
How sad that the fear of being sued can overcome the desire to have an open relationship between doctor and patient. I don't even know who to blame.
Thanks for being so honest (and not pretending to be a saint) about your dilemma.
As a parent, I want and uperhaps unrealistically expect you to be perfect but would rather you admitted your mistakes so we could deal with them together.
However, to be honest, if you made a really serious mistake that hurt my daughter, I can't assure you that I would not want to sue you and use your honesty against you someday! I don't see a good answer here.
A medical mistake is when the doctor fails to notify the patient of important results (or failing to investigate serious symtoms like focal seizures.) On the other hand, if a patient with influenza gets progressively worse over time and needs hospitalzation, this does not represent a medical "error". It can be the natural progression of the disease. As long as the doctor thoroughly evaluated the patient each time, he or she did the best she could.
I hear non-physicians talk about "misdiagnoses" all the time. They fail to understand that making a medical diagnosis is not so much like hitting a bulls eye as it is like chasing down and finding a dangerous criminal. It's a process that may take time, but hopefully, after gathering sufficent evedence you eventually have an arrest and conviction!
Dr. Anonymous.
I agree with some of the others - wish all doctors were perfect, but nobody is. I view my relationship with my doctor as a partnership. It's my job to stay healthy, and he helps me by interpreting the data, and recommending a response. He can never have all the necessary data, so has to use his judgement. That is not a perfect process, but it's the best we have. I'd hope my doctor would be honest and tell me he booted it. Then, we move on and work out the best course of action.
In my opinion, A natural response from the patient would be to become angry with the mis-diagnosis in the first place; what with the suffering that ensued. However to avoid losing a patient or being sued, the Dr. should then offer to re-evaluate his error, and treat the patient FOR FREE including the RX meds he presribes/Tests etc. from day one of the wrong diagnosis, until the problem is corrected and the patient brought back to health and normalcy. Wouldn't this be cheaper for him to do, rather than having to spend millions on a law suit AND having him reported to the AMA to warn other patients/Drs about his callous and inattentive attitude? There is no acceptable monetary compensation for the loss of a dear one (child or adult.) The Dr. should pay for all expenses from the date of the mis-diagnosis till death occured and include compensation to the family for funeral expenses. We as patients seem to accept errors with a smile because we liked our Dr. but also want restitution. I think one way or the other, the Dr. should find a way to compensate the family and hope and pray that the Good Lord will forgive him. Sorry Doctors, but I got "messed" up by one of my Drs and didn't have the money nor the energy to sue him to get compensation for something I have to live with on a daily basis now till I die. Sorry if I sound bitter but see it my way: His error (!?) - but my bad luck(!) as I didn't know how the system worked at the time.
My primary care misdiagnosed me with a potentially life threatening disease. I just happened to be in the office when she got the call telling her she had read the labs wrong. I was taken into a room to be seen and was intially confused about what was going on. When she finally got to the part where she told me she had misinterpreted my labs & I wasn't sick, I could see how distressed she was with herself in making such a grave error and found myself more concerned with how upset she was than that she had been wrong. Her apology was sincere and her emotions genuine and I was thankful that she had the guts to face me with such grace unlike most doctors who don't even acknowledge there had been an error.
I would never sue her because I knew she had my best interests at heart always and has always treated me with respect and compassion. My feelings are that more doctors need to strive to be more like her--kind, approachable, candid and compassionate. Everyone makes mistakes and I won't say that I didn't have some sleepless nights and a lot of anxiety, but I learned a great deal in my research that I can apply to the rest of my life. If I hadn't had such a good relationship with my primary care maybe things would be different but I believe the kind of energy you put out is the kind that is returned to you. She has always been kind and understanding to me so I feel I owe her the same in return.
I think the ideal would be for the doctor to apologize and explain why they made the mistake in the first place.
I don't expect my doctors to be omnipotent, just not careless. My son has recurring illnesses and asthma and pneumonia twice. He does not fit the mold for it, so I can see how me and our doctor would miss it. Nothing wears my action-packed toddler down. Not even pneumonia. Plus, you can't send every child for chest x-rays that has those symptoms.
I'm very involved in my son's health and feel it is my duty to be part of the team with his pediatrician and pulmonologist, not expect them to know everything that he experiences and acts out based on the occasional 30 minute visit.
Typically, I'm quick to apologize for my mistakes, but I can't imagine the added pressure of your job. You need to do what's best for your family and allows you to sleep at night. If anything, just apologize that the patient feels/felt sick and they're doing all you can to make their recovery quick. Good luck!
I'm a chronic pain patient and have been on OxyContin 80mg 2x daily and other meds for over 4 years. Recently both my doctors closed their offices and are now working elsewhere in town. The did not notify anyone nor even consider tapering me down or anything else. Time is running out. Any suggestions? Find another doc? sue? risk death?
Anyone?
to anonymous posting about chronic pain:
Please visit our Pain Management board to ask your question.
Thank you!
i would hope it passes not for sueing purposes but for respect. i just loss my babby youngest of six she is 3 yrs of age. my whole family is split apart now because she ended up passing in our home during the early morning sometime and the state took my others for mean while. doctors don't take time anymore if one test can save someone even if u can't find nothing is it worth to keep looking till u get the answer a lot can be found with blood work or x rays or ct or mri even saving your job if at all possiable look more into meds too someone says they can't have it or they are on one and you think it might interfear the whole thing in the end should be about saving someone sic and ill and respect if make an error and there is traggic.
sometimes an apology means very little. I recently had a procedure done in an ER physician who without any regard for my well being "opened me up" without waiting for the anesthetic take affect. Even though I screamed and sobbed uncontrollably this man actually yelled at me during the procedure to stop moving! He seemed irritated and angry at my outcry of pain. I am not the same person I was when I walked in. An apology? I would feel belittled.
As a current med student, this topic is something which has come up repeatedly in our discussions of professionalism and how to treat our patients. The consensus is my class is that it is always better to apologize; however, I believe that it is important to make certain you always are putting the patient first in your practice. An apology means nothing to the patient if the physician didn't express a caring attitude in the first place.
As a patient, I am more concerned about figuring out what's wrong with me than with whether my physician is correct or not. I take it upon myself to look up my symptoms myself, including what the less obvious causes could be, in order to make sure that nothing is being left out. Although I am in a slightly better position than most to do the research (since I have all the books already) and argue with my physician (she's more likely to listen to me than the average person outside of healthcare), I still believe that everyone should attempt to locate information on their condition in order to be better informed.
In the end, as a patient and a med student, I would always rather be told when there is a mistake made. I think the primary care physician should be the one to share the news, even if he or she didn't make the mistake, because that is the physician who knows you best. I also think it's important for the physician to show some emotion when apologizing. If the doctor is genuinely sorry, they shouldn't try to hold back their emotions. A doctor's primary job is to care for the patient, both as a patient and as a person.
I would like for this law to be passed. If the physician is less scared of apologizing and admitting a mistake to his patients, he may be more able to admit he made a mistake to himself. He may be more likely to investigate when he thinks he may have made a mistake somewhere along the way, which results in better outcomes for his patients.
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