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

* * * *

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:

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:

• What Are Medical Errors?
• When Doctors Err, Many to Blame

Technorati Tags: medical errors, malpractice, apologies, medical mistakes, health and wellness

7th Grade: Readin' and Writin' and Birth Control Pills

So you are innocently rummaging through your 13 year old daughter Susie's room and - to your surprise and horror - you find a packet of birth control pills, prescribed by a doctor at her school. Tearfully, Susie explains that she had not wanted to disappoint you and had sought the school clinic's help when she decided to become sexually active with dreamy Biff, her 14-year-old boyfriend.

You are, understandably, mortified and then incensed at the school: How dare they prescribe this strong medicine and support Susie's becoming sexually active without so much as a by-your-leave to you, the parent?

* * * *

By a vote of 7-2, the school committee of Portland, Maine recently decided to offer oral contraceptives (OCPs or "the pill") to students in their middle school health clinic. There had been 17 pregnancies in their three middle schools over the past 4 years (which does not include those that were not reported, or terminated, or ended in miscarriage). The director of Maine's Health and Human Services put it this way: "Clearly they are too young to be engaged in sexual activity, but the reality is that they are sexually active. It is our responsibility to offer a full range of primary care services to students. Fortunately it's a small number."

Students must first have their parents sign a consent for medical treatment at the clinic (in the ensuing uproar, this is often missed: parents must consent for their child to receive care at the clinic, but they cannot dictate the nature of that care). The treatment is confidential and the students can decide what, if anything, to tell their parents. Birth control prescriptions will be given after the student has undergone a physical examination and counseling by a physician or nurse practitioner.

And so the controversy has begun: is this a good idea or a bad one? Let's lay out the positions.

* * * *

As a start, let's see if we can all find common ground by agreeing that:

• Children this young should not be having sex. Period.


• Kids should be discussing their sexual behavior with their parents, who should play a role in their decision-making.


• Oral contraceptives are very strong hormones. Who knows what effect they might have on such a young child in the short run and in the long run? It would be good to avoid their use in young children whenever possible.

* * * *

Why this is a bad idea:

• It is not the place of a school to provide such medical care to kids in the first place, especially when it does not include the minor child's parents. It's another example of the government usurping rightful parental authority.


• By prescribing OCPs, the school is endorsing and even encouraging sexual activity at an early age.


• By not advising the parents, an opportunity to promote communication between parent and child is circumvented.

Why this is a good idea:

• The kids who ask for OCPs have already decided to have sex. Nothing is likely to dissuade them. The fact she is looking to prevent pregnancy is a positive health decision and should be supported.


• If it is mandated that parents be included in the loop, then those kids who (for whatever reason) do not want their parents to know, will not receive contraception. Avoidable teen pregnancies will occur.


• The school is where the kids are. If the school does not offer easily accessible health care, most kids will not get any at all.

* * * *

Where I stand:
I have to say, I'm quite torn about this issue. It can't be healthy for young children's bodies to be exposed to these powerful hormones. And I'm heartsick at the loss of childhood we are witnessing, of which this another graphic example. Kids are prematurely exposed to content and experiences that are clearly inappropriate, they are having sex at earlier and earlier ages, etc.

But wishing it were otherwise won't change the following: A survey by the Massachusetts Department of Education showed 1 in 3 children (and they are children) under the age of 15 are sexually active. And, if I had to guess, I'd say very few of their parents have a clue as to that fact.

Yes, we need more strategies to promote abstinence and delaying initiation of sexual activity. Yes, we need to be sure kids know how to make good choices and not fall victim to unhealthy peer pressures. Yes, children need to understand how to prevent pregnancy and sexually transmitted diseases should they become sexually active.

But it's also true - sad to say - that many young kids will no more listen to Dr. P than they will to you, their parents. And if your Susie has decided to have sex with Biff, and if she wants to be responsible and avoid pregnancy and sexually transmitted diseases, and if she doesn't want you to know, then, yes, a school-based clinic should provide her with the means to do so.

There are no good or perfect options here: we're talking the least bad. It ain't pretty but sometimes it may take a village to help Susie avoid getting pregnant - which, in my book, is pretty much the worst case scenario of all.

When your child's school asks for your opinion on this matter, how will you vote?

Related Topics:

• Sex Education: Who Should Teach It?
• Kids' Safe Sex: Supportive Mom Is Key

Technorati Tags: birth control, middle school, Portland Maine, sex education, sexual health, pediatrics

Infant Cough, Cold Drugs Withdrawn

[This breaking news is written by Michael Smith, MD, WebMD's Chief Medical Editor.]

Makers Take Their Products Off the Market Citing Potential Misuse, Not Safety

Oct. 11, 2007 -- The makers of all over-the-counter oral cough and cold medicines for infants announced that they are taking those products off the market.

"Potential misuse of these infant medicines, not product safety, is driving the voluntary withdrawal," states the Consumer Healthcare Products Association (CHPA), a trade group representing the makers and distributors of over-the-counter medicines, in a news release.

The withdrawal only applies to cough and cold medicines that refer to "infants," not to children who are at least two years old.

The CHPA today issued this list of branded cough and cold medicines that are being voluntarily withdrawn:

• Dimetapp Decongestant Plus Cough Infant Drops
• Dimetapp Decongestant Infant Drops
• Little Colds Decongestant Plus Cough
• Little Colds Multi-Symptom Cold Formula
• PEDIACARE Infant Drops Decongestant (containing pseudoephedrine)
• PEDIACARE Infant Drops Decongestant & Cough (containing pseudoephedrine)
• PEDIACARE Infant Dropper Decongestant (containing phenylephrine)
• PEDIACARE Infant Dropper Long-Acting Cough
• PEDIACARE Infant Dropper Decongestant & Cough (containing phenylephrine)
• Robitussin Infant Cough DM Drops
• Triaminic Infant & Toddler Thin Strips Decongestant
• Triaminic Infant & Toddler Thin Strips Decongestant Plus Cough
• TYLENOL Concentrated Infants ' Drops Plus Cold
• TYLENOL Concentrated Infants ' Drops Plus Cold & Cough

FDA Reviewing Products

In August, the FDA warned parents not to give children younger than 2 over-the-counter cough or cold medicines unless given specific directions to do so by a health care provider.

The FDA is reviewing the safety and effectiveness of nonprescription cough and cold drug use in children. An FDA panel will discuss the topic next week.

Trade Group's Comments

"It 's important to point out that these medicines are safe and effective when used as directed, and most parents are using them appropriately," CHPA president Linda Suydam, DPA, states in a news release.

"The reason the makers of over-the-counter, oral cough and cold medicines for infants are voluntarily withdrawing these medicines is that there have been rare patterns of misuse leading to overdose recently identified, particularly in infants, and safety is our top priority," states Suydam.

The CHPA and its member companies have recommended to the FDA that the labels on all over-the-counter cough and cold medicines for children 2 and older be strengthened from "ask a doctor" before using to "do not use" in children under age 2. That way, parents will be aware that these products are not recommended for infants.

The CHPA says it made those recommendations in preparation for next week's FDA panel meeting.

"These medicines are -- and always have been -- safe at recommended doses," states Suydam.

She adds that "these voluntary actions are being taken out of an abundance of caution. The vast majority of parents and caregivers safely use these medicines to help relieve their children's symptoms."

"But as with all medicines, it's important that parents read over-the-counter medicine labels carefully, use these medicines only as directed, and store them safely out of the reach of children," says Suydam.

SOURCES: News release, Consumer Healthcare Products Association. WebMD Medical News: "FDA Warns on Tot's Cough, Cold Drug Use."

Related Topics:
Do you have any of these products in your medicine cabinet? Talk with other parents on our message boards.

Technorati Tags: baby cough cold medicines withdrawn, infant cough cold drugs withdrawn, Consumer Healthcare Products Association