August 27, 2010
Admitting Our Mistakes
I’ve written before about how the error rate in the practice of medicine is far greater than that in other industries. I’m not talking about when doctors make a difficult decision that in retrospect was wrong; I’m talking about just plain mistakes, such as when one medication is ordered but another is dispensed or when the dose dispensed is 10 times greater than what was what was intended because of an extra zero was written in the order. We are finally looking to fields such as aviation to learn how to adopt safe practices in every part of patient care.
And though our error rate is too high, even with best practices it will never be zero. Even in aviation some planes go through the regular maintenance, go through the take-off checklist, and still crash. In a diner, an error might lead to a ruined meal. In healthcare, and error can lead to a catastrophic injury. So what should doctors do after an error has already happened?
The standard paradigm for handling medical error management has been the legal defense. Doctors were advised not to communicate with the patient or the family for fear that they would disclose something that would increase their legal liability. Patients and family members felt cut off from information just when they felt most injured and vulnerable. Doctors felt unable to continue caring for the patient and to express remorse for what happened. Rather than concentrate on helping the family and the patient recover from the mistake, the focus was on preparing for the anticipated lawsuit.
Fortunately, the paradigm is shifting. More and more institutions are moving to a policy of complete and prompt error disclosure. Physicians are trained to sit with patients and families immediately after adverse events, explain what happened, tell them what is known so far, and explain that the institution will promptly investigate the details of the case to see if errors occurred. Importantly, physicians can express remorse. If errors are discovered by the internal investigation, the patient or family are informed of the error and offered compensation.
This open approach has met with some resistance due to the fear that it would lead to more frequent malpractice suits and awards. A study in the current issue of Annals of Internal Medicine suggests that the opposite may be the case. The study reviews malpractice claims against the University of Michigan Health System (UMHS) from 1995 to 2007. In 2001 UMHS implemented a program of full disclosure of medical errors with offers of compensation. The study shows that the rate of lawsuits, patient compensation and legal costs all declined after the change.
So transparency and honesty after errors is not just the most ethical policy. It’s the better business policy too. The hardest time to be honest is after something goes horribly wrong, but that’s when patients most count on our honesty. Many patients and families are ready to forgive if they see that we are doing everything possible to assure the error doesn’t happen again. We now no longer have a legal excuse for not knowing how to say we’re sorry.
New York Times article: When Doctors Admit Their Mistakes
My post in 2007 about teaching physicians to disclose errors: Learning to Say “I’m Sorry”
My post in 2009 about adopting a culture of safety in healthcare: Got Safety?
Important legal mumbo jumbo: