Dealing With Medical Errors

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© SquaredpixelsAnother great article from Huffington Post!  I respect the candidness of the bloggers featured on their website.  Dr. Brian Secemsky is a resident physician in internal medicine currently training in San Francisco. His interests in medicine include preventive health, education and medical journalism .  Recently, he blogged about dealing with medical errors.

The scenario:

Ms. A was a sweet older lady with a bad heart.  She had a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, vomiting and dizziness prompting an urgent 911 call. Ms. A thought her symptoms were attributable to bad heartburn, but the results of the tests showed she had severe disease and was at a high risk for a fatal heart attack without surgical intervention. Dr. Secemsky cared for Ms. A overnight.  While treating her, he made the incorrect decision to administer a cardiac medication that is known to increase the risk of bleeding during surgery. Given her need for the operation, the benefit of providing this medication to safely temporize her heart condition in the short term did not outweigh the risk of delaying the intervention that she ultimately needed. Despite the standard of care regarding this clinical scenario, he made the wrong call.

Background:

Making a medical error is the most feared consequence of practicing medicine. Any slip in clinical judgment can potentially cause serious injury or even death. A study conducted by the Institute of Medicine (IOM) demonstrated that medical errors in the U.S resulted around 75,000 unnecessary deaths and more than one million excess injuries each year. Despite this data, it is remarkable that medical errors are made every day and usually result in little to no negative patient outcomes. Whether one is just starting out as a physician in medical training or is a leader in their respective field, all medical providers will make mistakes during their careers. Given the fact that this is an unavoidable facet to making thousands of clinical decisions each year, how does one appropriately deal with such errors?

Unfortunately, many practitioners choose not to deal with medical mistakes at all. In a study surveying the prevalence of non-disclosed medical errors, Taylor et al. found that more than 30 percent of physicians and nurses underreported almost half of medical decisions that they perceived as clinical oversights. Not only is this blaringly unethical, but also limits the medical community from creating stopgaps to avoid such errors in the future.

The Solution

There are several steps to appropriately dealing with a medical error that are relatively straightforward:
1. Let the patient and family know.
Many health care providers fear that notifying patients of an error will decrease rapport and put them at a higher risk for receiving malpractice lawsuits. Interestingly, a report by Boothman et al. from the University of Michigan demonstrates otherwise. The more that patients and their families are notified of serious mistakes, the less they are inclined to reactively sue. Regardless of the tangible consequence of making a medical error, practitioners have the ethical duty to let their patients know of any significant clinical oversights.
2. Notify the rest of the care team.
Alerting the rest of a patient’s care team of a medical error is not easy. It essentially demonstrates one’s fallibility to his or her colleagues and may result in considerable changes to the predetermined patient-care plan. Despite this, these errors must be relayed to the rest of the care team in order to better handle any immediate significant negative patient outcomes and reduce further mismanagement from occurring.
3. Document the error and report it to the hospital-safety committee.
In order to avoid further complications to a patient’s care, it is essential that the medical error be appropriately documented and reported. By doing so, it avoids further complications by independent health care providers who also assume care of the patient and can globally increase patient well-being by improving hospital-wide safety measures.

Physicians must disclose mistakes

The American Medical Association takes the position that a physician has an ethical duty to disclose a harmful error to a patient.  In practice, it may be difficult to disclose, let alone describe, an error without apologizing. Failure to accompany the disclosure with an apology might be interpreted by the patient as a lack of remorse.  If the error occurs in a hospital, The Joint Commission requires that the hospital disclose it to the patient. This requirement, like the AMA’s ethics rule, may put the physician in the position of either apologizing or appearing callous.  In recent years states have begun to add the force of law to these ethical and regulatory disclosure requirements. For example, a number of states now require hospitals to disclose all serious errors. If a physician was involved, the disclosure creates pressure to apologize.

 

Two kinds of ˜Apology Laws’

Several states have also enacted so-called œApology Laws, which should mitigate the conflict a physician faces when trying to meet the patient’s desire for an apology while avoiding self-incrimination.

These Apology Laws change the traditional evidentiary rule by providing that apologies are not admissible in civil actions for medical errors.

Apology Laws fall into two categories. One category protects apologies and acknowledgements of fault”admissions of responsibility”that go with the apologies. Colorado has a statute in this category. The second category protects the apology itself but not any acknowledgement of fault. Indiana has this second category. The œcommunication of sympathy is inadmissible, but a œstatement of fault ( if any is made) remains admissible

The Take-Home Point

Committing and dealing with a medical error is one of the more humbling experiences in the field of medicine.

Given the fact that making clinical errors in judgment is an inevitable aspect to clinical practice, it is imperative that practitioners of all levels of training be aware and comfortable in appropriately handling such events.

Related Stories:  Thousands of doctors practicing despite errors and misconduct,  Patients may need better info when leaving hospitals & 1 in 4 surgery errors due to technology problems

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