Medical errors – apologies required
Our Chief Privacy Officer sent me an interesting article today about how hospitals are promoting “disclosure and apology” (by physicians to patients or their families) when a medical error is committed. The report suggests that less money will be spent in malpractice suits if physicians fess up to their mistakes instead of trying to hide them.
Another study suggests that 99% of physicians believe that it is morally right to confess errors to patients and family members, but that only about 33% report doing so. The article says that the number one reason why they don’t report errors is fear of being sued.
While these statistics don’t reflect well on physicians, I think there’s some murkiness here that’s worth reviewing. First of all, what constitutes an error? When a young resident physician performs a procedure in an inferior manner due to lack of experience, is that an error? When a code team is not called soon enough because a patient doesn’t appear gravely ill initially, is that an error? If an unconscious patient arrives in the ER and is treated with a medicine that causes a life-threatening allergic reaction, is that an error? I think that many times physicians perceive some “errors” as unfortunate and regrettable aspects of the natural practice of medicine and don’t report them formally.
Another reason why physicians may not report errors is because it’s unclear that the error has a specific adverse effect – perhaps a patient’s Tylenol was given at the wrong time of day. That’s an error – but is it worthy of formally reporting it to the patient? What about when the lab loses the tube of blood drawn from a patient? Should the patient be told about it or should the labs be added to the next day’s scheduled draw?
The majority of “errors” that I’ve witnessed are in the realm of sub-optimal care due to inexperience, inattentiveness, or misinterpretation of test results. However, errors of the sort that result in death and serious harm appear to be alarmingly frequent (some studies argue that there are 40-90 thousand of these errors per year).
I think that physicians should always tell patients the truth about their care, the risks associated with certain procedures, and the full range of choices that are available to them. I do believe that patients value (and deserve) to know the truth - even when it makes the physician or hospital seem less than perfect. In the cases of errors that result in serious consequences – honesty is the best (and only) policy.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Unfortunately, a patient of mine had to deal with a very significant error just yesterday.
As part of the infertility evaluation and prior to treatment sexually transmitted disease testing is required. This includes testing for HIV. If intrauterine insemination is planned both partners will have blood drawn and sent to a national reference lab for HIV, syphilis, as well as hepatitis B & C testing. Often the first test is a screening test and overestimates the true incidence of infection. Because even the hint of a positive test can be traumatizing, we often opt for the more definitive HIV Western blot testing which is a confirmatory test.
In this particular case, the report came back that all antibodies tests for positive for HIV. After speaking with the lab director, I called the patient in to obtain a second sample (as I am concerned about making any diagnosis on a single sample) and explained my concern about the possibility of an HIV infection. The next day, I received a call from the lab director that both retesting the first sample and the new sample confirmed that this person did not have an HIV infection. “A splash must have occurred.” was the only explanation given. Luckily, when an inaccurate report is called back, a full investigation as to the cause is initiated so hopefully someone else won’t have to suffer needlessly.
This individual was obviously relieved at getting the good news and shared that as a couple they took the day off to figure out how their lives would be different living with HIV. As a result of the negative results, they chose to celebrate the blessings they had which we often take for granted.
How would you respond to a similar experience?
Wow, what a story! I think you did the right thing all the way… getting the most accurate test, double checking the results… informing the patient, and then rechecking again. It is a shame that the couple had to suffer for a short time with the wrong diagnosis, but I’m sure they appreciated your aggressive follow up and “getting to the bottom of things.” I was personally the victim of a lab mix up (I was told I had cancer when I didn’t) and it was incredibly traumatizing. Unfortunately I had to wait for a month for a confirmatory test, and my doctor wasn’t as responsive as you were.
Did anyone see the article in the Jan. 29 New Yorker about medical errors? Fascinating, and scary to hear how a patient’s youthful or fit appearance can cause doctors to prematurely rule out certain conditions.