In the very best of times, healthcare practitioners are repeatedly exposed to emotional turmoil caused by patient tragedies such as loss of life, even when it is clinically anticipated. The deaths of patients illustrate the complex sorrow intrinsic to the work of healthcare practitioners. Thus, it is not difficult to see how patient tragedies caused by medical errors can shake the involved practitioners to their very core. Fatal errors and those that cause harm are known to haunt healthcare practitioners throughout their life. The impact of the errors is felt in their private lives, in interactions with professional colleagues, and in the context of their social life. Immediately after the error is recognized, the practitioner typically experiences stress-related psychological and physical reactions related to sadness, fear, anger, and shame (e.g.”medical malpractice stress syndrome”). Serious errors also result in competent practitioners losing their licenses or leaving the profession.
On the other hand, compounding the problem of medical errors is the fact that often, patients don’t even know when a mistake has occurred. Only one-third of patients are told about a medical error when it happens, multiple surveys find.
Traditionally, physicians have avoided apologizing for errors that harmed patients. Part of the reluctance stemmed from pride or wanting to avoid shame.If I apologize, could my words come back to haunt me if a lawsuit is filed- a typical dilemma faced by physicians after committing a medical error.Also, apologizing in a medical context can feel like saying, “I am incompetent.”Harvard University’s Robert Blendon conducted the first survey on the topic in 2002. He found that 30 percent of the patients who said they experienced medical harm were told about the problem. Doctors reported a similar rate when they received health care (31 percent).
A separate review study, published in 2004, found that about one in five doctors said they had disclosed their most serious medical error of the last year. This could be one reason that, despite medical harm being a leading cause of death, many don’t see it as a pressing issue for the health care system to address.
Interestingly, some lawyers continue to advise physicians not to make admissions that could be used in a malpractice case. Their reasoning: If a doctor does something that adversely affects a malpractice insurer’s ability to defend the case, the insurer might not provide liability coverage for the adverse event.
However, when medical errors occur, effective physician-patient communication is critical. Ethical and professional guidelines make clear that physicians have a responsibility to disclose medical errors,and recent standards link disclosure of unexpected outcomes to hospital accreditation.
Conway J, Federico F, Stewart K, Campbell MJ. Respectful management of serious clinical adverse events. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2010.
Mossman D. Are your admitting malpractice if you apologize to a patient? Current Psychiatry 2013; December ; (112):30-33