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Disclose a medical error right,
reduce everyone's stress
1 Admit the error You
should clearly state the facts, explaining what
happened. Don't try to squirm out of it, and never
use euphemisms
2 Be compassionate Show
the patient you care about what they're going
through
3 Why it happened In
order to find closure, the patient will want to
understand what went wrong
4 The consequences The
patient will want to hear how the error will affect
their treatment and share in the decision about
where to go from here
5 Lessons learned Patients
want to know how you're going to make sure this
never happens to anyone else, and how the system
has learned from the mistake. "This isn't intuitive
to doctors," notes Dr Levinson
6 Apologize "This is
controversial," says Dr Levinson. "Some doctors
prefer regret. But an apology is a very powerful
way to connect with the patient. Think about when
someone apologizes to you — it's hard to
stay angry when someone's genuine."
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Medical errors don't just harm
patients. The doctors involved in the mistake bear a
huge burden of stress and guilt — and it can affect
their performance, according to a study in the August
Joint Commission Journal on Quality and Patient Safety.
Researchers surveyed 1,404 Canadian
and 1,767 US physicians about their experience of medical
errors and error disclosure. Physicians were also asked
if the error had affected their job satisfaction, self-confidence,
reputation, anxiety level and ability to sleep and if
they'd be interested in counselling.
Overall, 81% of physicians reported
experiencing at least one of these stressors. Not surprisingly,
physicians who'd been involved with a serious error
were most likely to report feelings of stress. Sixty-one
percent became more worried about committing errors
in the future, while nearly half reported their confidence
in their abilities and sleep were affected after the
error.
I caught up with surgeon and medical
error expert Professor Matthias Rothmund of Philipps
University in Marburg, Germany, at the International
Surgery Week conference in Montreal last week. He says
he's seen the consequences of medical errors on his
surgeon colleagues all too often. "They become depressive
and hesitant. It affects their self-confidence," he
says, adding, "It's worse for older doctors — they've
seen everything and don't expect to make mistakes."
MDs
ERR, ARE HUMAN
Why do physicians take errors so hard? "There are many
reasons," says Dr Wendy Levinson of U of T and one of
the study authors, speaking by phone. "There are doctors'
own perceptions — that we should do no harm —
there's fear of malpractice, and it's just not part
of what people talk about. It doesn't fit with the perfectionist
personality of medicine."
Ever since the Institute of Medicine's
1999 report To Err is Human revealed that as
many as 100,000 people die in US hospitals each year
from medical errors, patient safety has rightly become
the top agenda in North American hospitals. In Canada
the field is still relatively new, as is dialogue about
error disclosure.
Disclosure of errors was a major
source of stress for the physicians surveyed, four times
more so when the doctor felt the conversation went poorly.
Eighty-six percent of physicians in the study said they'd
be interested in training to help them talk to patients
about errors. "This hasn't been part of our training,"
says Dr Levinson. "Traditionally, there's been a blame
culture, like M&M rounds, which is a very punitive
environment. No one looks forward to presenting a case.
And lawyers always told doctors to hide it, to not talk
to colleagues when they made a mistake. We need systems
that support us to do the right thing."
In the study, 90% of doctors said
they weren't adequately supported by their hospital
after an error. "It's all focused on the patient," agrees
Professor Rothmund. "Nobody cares about the doctor."
Dr Levinson says things are starting
to improve. Canadian hospitals are slowly beginning
to set up 'just-in-time' coaching programs, to help
physicians process and cope with the error before they
disclose it. She notes that on the legal side, Quebec
and Manitoba have made disclosure mandatory, and BC
recently introduced legislation to legally protect doctors
who apologize.
GETTING
HELP
Despite all this, physicians are still not taking advantage
of counselling and other help. Eighty-two percent of
the doctors in the survey said they'd be interested
in counselling, but nearly half of them cited serious
barriers such as time and stigma.
Many of them also have a hard time
sharing the blame for the error with others. "Doctors
are ambivalent," says Dr Levinson, "especially surgeons.
They think 'I'm the captain — the buck stops here,
it's my fault.' But it's often due to systems failures.
If someone operates on the wrong side, it wasn't just
the surgeon's fault."
Professor Rothmund doesn't see
much being done to better equip physicians - especially
older ones — to cope with errors. In the meantime,
he says, most docs will continue to rely on their own
personal psychologists, a good husband or wife. "That's
who to talk to."
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