Adverse events and medical
errors are a part of clinical practice.
A report from the Institute of
Medicine “To Err is Human: Building a Safer Health System” published in the
year 1999 has defined medical error as “the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim”. Some
examples of errors as mentioned in the IOM report include transfusions,
surgical injuries and wrong-site surgery, restraint-related injuries or death,
falls, burns, pressure ulcers and mistaken patient identities. The IOM report
also noted that errors occur more commonly due to faulty systems, processes,
and conditions that lead people to make mistakes or fail to prevent them.
According to the Journal of
the American Medical Association (JAMA), medical negligence is the third
leading cause of death in the US, behind heart disease and cancer. In 2012,
over $3 billion was spent in medical malpractice pay-outs, averaging one
pay-out every 43 minutes. Every year, 200,000 patients in the US die due to
medical errors.
Should a doctor apologize for
his/her mistake? A very common, perhaps natural, apprehension is that
acknowledging a mistake before the patient may leave one vulnerable to
litigation. Admitting to a mistake may also undermine the doctor-patient
relationship. Doctors are often counselled not to apologize to patients. A
common view is that if you say you’re sorry for something, you are implicitly
taking some degree of responsibility for whatever has happened; in other words,
saying sorry is an admission of guilt.
But, apologizing after a
medical error is the humane thing to do. Often, patients sue simply because
it’s the only way to find out what went wrong. Physicians should inform
patients, no matter what caused the events, of the facts and the nature and
circumstances of the problem while expressing regret and showing sympathy for
the situation (Can Fam Physician. 2007 Feb; 53(2): 201). Doctors should
always communicate with their patients. A two-way communication is the key to a
strong doctor-patient relationship.
Remaining silent and not
communicating to the patient may sometimes result in distrust and an angry
patient, who is only too willing to sue the doctor. Apologizing at this point
of time may not work to defuse the situation. Many states in the US have passed
‘Apology laws’ that do not permit apologies to be used against
doctors in malpractice court
Apology the spiritual answer
· The word ‘sorry’ is synonymous with apology.
· To err is human and to admit one’s error is
superhuman.
· Sorry should be heartfelt and not ego felt. You
should not only say sorry, but you should also mean it. An insincere apology may
only complicate matters further.
· It requires tremendous courage to face the victim
of our wrong doing and apologize.
· It is generally seen that those who are in harmony
with their life and consequently with themselves, find it easier to say ‘I’m
sorry’. They are the positive, conscientious ones who are at peace only after
making amends for their misdeeds.
· The word ‘sorry’ in itself is imbued with so much
potential and power. Within a fraction of a second, grave mistakes are diluted,
tepid and estranged relations are brought alive, animosity and rancour are
dissolved, misunderstandings resolved and tense situations ease out resulting
in harmony and rapprochement.
· To forgive and forget is a common spiritual saying.
· Remember we all do mistakes and seek forgiveness
from God every day.
No doctor practices medicine
with an intention to harm the patient. Beneficence and non-maleficence are the
guiding ethics of clinical practice. But, despite all care, sometimes errors
may happen inadvertently. To err is human and every doctor is likely to make
mistakes.
Difference of opinion, error
of judgment, medical errors and medical accidents are not medical negligence.
Experiencing a bad outcome does not always mean medical negligence. This has
also been the position of the Supreme Court of India in its various judgements.
For medical negligence, there is always an element of wilful omission
and commission, which causes injury or damages to a patient. Such an act is
liable for medical negligence or malpractice claim.
Disclaimer: The views
expressed in this write up are entirely my own.
No comments:
Post a Comment