AIIMS
New Delhi, a premier institute of the country, has tendered an apology to a
patient who underwent a wrong procedure.
The
written apology was sent to the 30-year-old patient, a resident of Bihar, and
her husband was contacted with an offer for additional treatment. Allegedly, an
arteriovenous fistula was made in the patient who did not have any
kidney-related illness and instead was seeking treatment for pain in abdomen.
AV fistula is created surgically in chronic kidney disease patients undergoing
dialysis. Documents were allegedly tampered with to cover up the medical
negligence.
Primum
non nocere i.e. “first (above all) do no harm” is the cardinal principle that
guides the ethics of practice of medicine. From it is derived the principle of
non maleficence (do no harm) and its natural corollary, the principle of
beneficence (do good).
Doctors
never harm a patient intentionally. But sometimes, errors do happen even with
all precautions.
In
the event of any unanticipated adverse incident or outcome that may cause harm
to the patient, patients now want answers. They can no longer be pacified with
medical jargon; instead, they want to know the facts of the matter and the
circumstances leading to it. They also want to know if a medical error could
have caused the adverse outcome and want doctors and establishments to
apologize to them, if the error was ‘avoidable’.
Non
disclosure or ‘hushing up’ of errors increases feelings of anger and blame in the
patients and creates distrust between the doctor and patient. And the aftermath
is well-familiar to us all – negligence lawsuits against doctors and hospitals
or angry relatives and friends ransacking the hospital or assaulting the doctor
and other staff.
Apologize
to the patient in such situations…an apology works.
While
an apology does not undo the damage caused, it can alleviate the resulting
feelings of anger and distrust. An apology can be either with admission of
guilt or without admission of guilt.
But
doctors find it difficult to admit to a mistake. Doctors are apprehensive -
quite rightly so, given the absence of apology laws in the country - that
apologizing for a mistake can be considered an ‘admission of guilt’ and used as
evidence in courts of law.
Some
states in the US have apology laws that protect an apology from being
admissible as evidence in courts of law in medical negligence cases
While
saying sorry for any wrong done is an immediate instinct of human nature, on
the other hand, the fear of ensuing litigation prevents doctors from admitting
to their mistakes. It is a classic ‘Catch-22’ situation because the outcome may
anyway be a medical malpractice claim now or at a later date, when the mistake
may be discovered.
Saying
“I/We have made a mistake” and acknowledging that mistake with an apology takes
lot of courage. But it goes a long way in restoring trust between the doctor
and the patient and may defuse a situation that is just ready to explode.
Opinion
8.121 of the American Medical Association (AMA) Code of Medical Ethics says
“Physicians must offer professional and compassionate concern toward patients
who have been harmed, regardless of whether the harm was caused by a health
care error. An expression of concern need not be an admission of
responsibility. When patient harm has been caused by an error, physicians
should offer a general explanation regarding the nature of the error and the
measures being taken to prevent similar occurrences in the future. Such communication
is fundamental to the trust that underlies the patient-physician relationship,
and may help reduce the risk of liability.”
The
Joint Commission standard also says, “Patients and, when appropriate, their
families are informed about the outcomes of care, including unanticipated
outcomes” (RI. 1.2.2).
Related links
·
Medical Errors: “I am sorry” http://drkkaggarwal.blogspot.in/2017/09/medical-errors-i-am-sorry.html
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart
Care Foundation of India
Immediate Past
National President IMA
