Just recently, I called a patient to tell them that my error had probably resulted in a delay in the diagnosis of their serious medical illness.* As soon as I had realized the error, I had thought and thought about how to broach the topic with them. Finally, late in the day, after everyone else had left the office, I found a reason to dial, and I did.
I sat at my desk trying to explain the issue as factually as I could, without emotion or excuses. But my hand gripped the phone a little extra-firmly, and I know my voice betrayed my anxiety as I stated: “I am so sorry about this.”
Medical errors, which include anything that results in a delay in diagnosis, are exceedingly common. This is a bit of a hot topic right now, and I have an upcoming article for the Harvard Health Blog where I discuss an entirely different patient and error of mine that also resulted in a delay in diagnosis.The topic is timely, as a leading medical journal just published data to suggest that medical error is, essentially, the third leading cause of death in the U.S.
Maybe readers are thinking I’m a doc who makes alot of mistakes. Actually, I’m just one of the few who is willing to discuss them. Folks, the data doesn’t lie: medical errors are rampant.
The day I filed my draft post, NPR published this article about an American surgeon who confessed that decades earlier, he sat on the witness stand in a malpractice case, and lied in order to protect another doctor. This surgeon had had doubts about his colleague’s competence, and had seen harm done. But he got up there and stated for the record that he had never questioned the doctor’s skill. And now, he openly admits that he lied under oath.
Wow. Hard to imagine, right? Well, as he describes, the culture in medicine can create overwhelming pressure to rationalize/ excuse/ hide mistakes. What it boils down to:
“Doctors don’t squeal on doctors.”
That is the attitude I often witnessed throughout training. Even now, it is very difficult to discuss a mistake with a colleague. If it’s your mistake, they’ll jump into defensive mode along with you. If it’s their mistake, well, God help you. Either they’ll jump into defensive mode, or they’ll just get pissed off. Bringing up mistakes is considered very poor taste. Because doctors back each other up, right?
That toxic attitude is what makes medical errors so common. It’s inevitable that we will screw up. We should hope to learn from them, and share the lessons, in order to prevent similar errors. But in order to do that, we kind of have to admit we screwed up in the first place.
Awhile back, I wrote a post for the Mothers In Medicine group blog titled I Screwed Up and I’m Sorry and Damn It, I’m Going To Say So Out Loud, which was about medical errors and how I came around to my current policy of: “Admit and discuss everything no matter what”. In all honesty, it feels much, much better to come completely clean on any and every mistake. I can’t fathom how any provider could sit on these kinds of things, much less lie on the witness stand.
I do sense that there is a cultural shift on this, and it may be because the hospital where I work is trying to take the lead. Errors reporting is actually encouraged, and I am hopeful this will become more common.
Meantime, I will continue to use myself as an example.
My patient from above, they were very gracious, and even moved on to other topics. Who knows? They may have second thoughts.
I’ve analyzed what happened and thought of how to prevent it in the future. I’ve been as transparent and straightforward as possible. But my mind and conscience can rest easy.
*This is true, but I can’t get more specific for fear of violating health privacy laws.