Sunday, September 24, 2017

Medical Errors: “I am sorry”

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.

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