Thursday, May 24, 2007
Do doctors disclose mistakes?
Something that caught my eye this morning was a story about whether doctors report medical errors. It was a fascinating survey, published in the Journal of General Internal Medicine, of doctors regarding disclosure of mistakes. There were lots of different numbers, but allow me to summarize by saying that around 20 percent acknowledged that they had not disclosed a minor error and around 5 percent acknowledged not disclosing a major error. Keep in mind, this was just a survey of doctors, not a study of actual medical errors.

The article also prefaced the results by saying that physicians inherently think it's important to disclose medical errors, yet many do not do so when it comes to their own mistakes. As we sat and talked about this in the newsroom, it seemed everyone had an opinion. Many non-physicians think doctors are all part of an "exclusive club" where they take care of one another and block disclosure of mistakes. Others pointed out that we live in a very litigious society, where doctors are running scared and fearful of lawsuits. Many thought doctors would never disclose an error and believe they often withhold information from patients.

I was a little surprised at all the conjecture. Still, it taps into some important attitudes toward doctors and perhaps the trust of the medical establishment in general. What do you think? If your doctor made a mistake, do you think he or she would tell you?
I'm not surprised that doctors don't want to report their errors. Many times, doctors will even try to hide problems that they've had with former employers (i.e. malpractice suits, etc.). With all of these electronic medical records "flying around," it would be beneficial to have an electronic record to keep track of physicians' histories as well!
As long as the prevailing social climate is hostile towards physicians and their ability to practice quality medicine, they will not practice with full transparency. The general public does not realize the sacrifice that physicians make in devoting 7-11 rigorous years of their lives after college towards learning and honing their clinical skills. Expanding this argument to discuss America's healthcare crisis, doctors are caught in between having to take of patients while battling pharmaceuticual and HMO interests. In addition, the public is not well-informed to know that the media-touted drugs and technological treatments are not necessarily the best, but they are definitely expensive. Give physicians the authority and respect to practice medicine with accountability, but without fear and restrictions, and you'll see medical care improve, drastically.

-Melvin Ku
Medical Student
MSU-CHM Class of 2011
I experienced a few "mistakes" last year. The first was after a steriod injuection to relieve pain in my neck- when I woke up- the dr. said " I always read that if you left the needle in too long it would make the patient sick. I have never done it before and I will never do it again. That Dr. was not so willing to admit he even made that comment much less a mistake. ( he said it in front of witnesses too) and the 2nd time was after surgery. A hemotomia developed under my skin at the suture site about the size of an egg and caused TREMENDOUS pain. My husband rushed me to the ER at 430 am and I was taken into emergency surgery early that afternoon to remove the hemotomia and clean out the site. I spent longer in the hospital the 2nd time than I did the for the actual surgery! While my Dr did not say to my face "I made a mistake" - He did tell me that he missed a small vein in my neck which caused the hemotomia. I never saw any bills related to my 2nd hospital stay and while yes my doctor made a mistake, he is human and I feel that he took care of me as best as he could. In fact; I would see him again if I ever need more surgery in his area of experience.I have even recommended him to friends and co workers who are in need of a surgeon. I would love to say his name as I just love him but will refrain.
I see a number of doctors for a variety of medical issues. I have had doctors tell me that they have made an error in either prescribing a medication or requesting a test. I realize that the human body is complex and not everything is known. I have more confidence in a physician who is not afraid to admit that s/he needs to do research or prefers to send me to a specialist. I am most concerned about a physician who can't admit that s/he overlooked something when presented with concrete evidence or who will not listen when I try to explain my problem.
what is a medical mistake?

are there diferent definitions?

ie. lawyer doctor family
For those that looked at Melvin's comments, make sure you listen to who is talking. While he lists himself as amedical student, he is not. He will not be a doctor of medicine, but is going to school for a masters degree in biology. Oh, and look at the class year - he has not even started school yet.
I have been in medical practice in the USA for 12 years and can say honestly I ALWAYS tell patients of medical errors or complications. I was taught long ago in Ireland that people understand imperfection - they do not understand nor accept deceit, arrogance or lies. Current recommmendations by medico-legal societies support this.
It's interesting we all make mistakes in our jobs whether it be a minor or a major one. To be in a position of a doctor or police officer, society expects that none be made although we all know that no one is perfect. Because we are such a sue happy nation, I don't blame doctors for not disclosing their mistakes to save their practice. Of course I'd rather have honesty from my doctor but we the people have created this system where we don't forgive minor mistakes. We're such a sue happy society that at some point - no one can make a mistake.
I wholeheartedly disagree with Melvin's sentiments, which seem to shift the blame away from medical doctors. Malcolm Gladwell's bestseller Blink discusses the fact that doctors with a more approachable, less dominant bedside manner are much less likely to be sued regardless of competence levels. So instead of striving for robotic precision, perhaps doctors should just try to be a little nicer. Apparently, the sense of feeling "wronged" by an M.D. stems as much from a social injury as an anatomical or physiological one.

Give patients the respect they deserve, and you may see the medicolegal environment improve drastically.
I feel that doctors would not disclose information that they made a mistake. I also believe that they wait for us to ask any and all questions rather than giving us important information that we may not otherwise have known to ask. Therefore leaving the responsibility or even the blame on the patient for not being better informed on their own about their health.
One of my co-workers mentioned to me that her mother went in for surgery for her leg. To make sure the doctors would not operate on the wrong leg, she marked her leg that needed the surgery with a magic marker and showed to the nurse not to make a mistake. Regardless the fact that her doctor re-assured her that they will be carefully attentive about it, she has no faith in the medical team. Nobody likes the idea of medical error committed onto their bodies.
No. I do not believe they disclose their mistakes. Our 43yr old neighbor's doctor told him he had hemmorroids. A year later he was diagnosed with colon cancer which his father had died of. He died a little over a year later. His wife asked for a copy of his medical records. They had been obviously eraced and rewritten to say "reccommended colonoscopy but patient refused".
I think the fact that states have had to pass laws ALLOWING doctors to apologize by protecting them from liability if they did so. This is just evidence that doctors are in a hostile environment where they aren't comfortable (due to legal reasons) to speak frankly with their patients without the fear of being sued for speaking honestly.
I can tell you from personal experience that doctors DO NOT disclose their mistakes--they work hard to cover them up! My OB/GYN performed what was supposed to be a "routine laprascopic" hysterectomy on me 2 years ago that was anything but routine! My bladder was punctured when a catheter was inserted during the surgery, AND it was also sliced with a scalpel. I ended up with a "bikini-line" incision that stretches 8" across my abdomen--so much for "laprascopic." They had to call in a urologist for emergency bladder repair--and it turned into a 5 hour surgery. After they sliced me open, they found that the stitches used to sew my vagina shut after my uterus had been removed weren't holding--and I was already starting to bleed profusely internally. And after all that--all I was told in the recovery room was that "complications arose during surgery" that necessitated the huge incision. It was only when I requested my medical records from the hospital, the urologist, and my ob/gyn--and compared all 3--that the truth came out. To this day I still have bladder problems, and post-op pain. I just turned 33... and I face a LONG life with bathroom issues ahead of me. FYI--I have NOT sued my doctor for medical malpractice--although I've since discovered that I'm not the only woman whose bladder he's ruined during surgery. So are doctor's "honest & forthright"??? Hardly....
A doctor who won't admit s/he has made a mistake or who bluffs through questions will never have my trust! I experienced this several years ago with a doc who either lied or later had a convenient memory lapse about a ruse to put me on unneeded medication. Thank goodness this spurred me to find a much better doctor and practice. They respect their patients and aren't afraid to say "Let's try this" or "I don't know (but will find out)".
Doctors are not god. They are human. They are not perfect. There is also the difference between an accident and negligence. Doctors should be respected for their willingness to serve the community. Doctors should be given the ability to practice with safeguards and be held accountable for their actions.

Doctors and patients have a symbiotic relationship. Both have to build this based on a certain amount of trust, knowledge, and analysis. I firmly believe that patients should not put total faith in their physician.
Why? Again, physicians are not god and each patient has the option to research symptoms, conditions and medicine. Books and the Internet allow patients to have an understanding about the ongoings of the body as well as the discoveries made by physicians.

Ultimately, the best relationship, between a patient and doctor, is one in which (1) the patient does his/her homework, is informative and asks questions and (2) the doctor takes the information disclosed by the patient - (a) analyzes it, (b) prescribe treatment (c) and knows when if that treatment isn't working to send the patient to a specialist.

The patient should not be afraid to question a doctor's decision or revisit the matter with another doctor.

Patients have to make decisions, they can't just give Doctor's the only say in the treatment of their illness. Patients have a responsibility to themselves.
Response to first Comment posted by Anonymous

Many states have this information available for free online. In my home state of florida we have a site that provides General Information, Education and Training, Academic Appointments, Speciality Certification, Finanicial Responsibility, Proceedings & Actions and Aditional optional information. I always check this resource before visiting with a new doctor.

Also, it doesn't surprise me that doctors would not disclose errors. The majority of physicians have worked for years to get where they are, are struggling with a reduction of insurance payments and an increase of patients that would sue them if they looked at them wrong. Of course, it seems the older docs can never admit a mistake but I think this comes with every profession.

Do research on your physicians and understand that they are human beings and can make mistakes.
The definition of "mistake" is what complicates the issue. To one an excepted risk, post-operative bleeding, is a mistake because it was not prevented. When "mistake" is easily equated with negligence, an unreasonable failure to do, or not do something, for which there is potential leagl liability, a physician, like any other human being, goes into defense mode. The entrenchment is manifested by a wide array of postures, that vary from person to person and group to group. The problem comes from the fact that when one is in this defense mode, the focus is on "I." That focus alters the basic premise of the physician-patient relationship, which like any solid fiduciary relationship, focuses on "the other."
Dear Dr. Gupta,
This is my first time writing-I am desparate for an answer. I am currently treating with a urologist for a bladder infection I have been battling for a month. Following the last dose of my fourth antibiotic, as usual, the infection came back. I called the doctor's office for the next step. Through his office staff, he said he wanted me to come in for an appointment and would not prescribe any further antibiotics before that. The appointment is 5 days from now. I explained that I have only 3 days worth of Cipro (left over from the beginning of the infection) and that I needed just 2 days more to protect me up to the date of the appointment so the infection would stay under some control and not progress to my kidneys (which it does very rapidly with me, and the doctor knows that). I was denied the 2 days I requested and told to go to the ER if a reinfection re-occurs. I was floored by this response. He's my doctor - a specialist, no less. Isn't he bound to make sure my health is protected up to the time of his appointment, when he's made aware that there could be a problem? Shelley, Lake Hopatcong, NJ
I don't thinks so Sanjay, not the doctors that I know, however, my little brother is studying medicine , and I think he would tell.
I really think that question is a joke. I don't know about american doctors but I doubt the doctors in france that misdiagnosed my raptured appendix and left me in toxic shock and with a huge nasty scar on my stomach WILL ever disclose the massive blunder.
My son was injured on his lip during a cleft palate surgery. The surgeon never responded to our questions and it is not noted in his medical records. My son now has a noticeable scar on his lip and the surgeon and the hospital has not ever acknowledged that an accident or mistake occurred. I will never go back to this physician and tell everyone about it. The hospital went so far as to accuse my husband and I that my son's lip was injured at home. If we hadn't taken a photograph in the hospital no one would have believed us. After saying all of that, the hospital still hasn't changed their records to reflect this accident/mistake.
I recently burried my 52 yearold wife. She had Bypass surgery . 4 days after , someone decided to do a MRI on a saturday night at 11pm. If it was an emergency why wasnt I notified??
She was laid down flat which caused her to stop breathing despite the fact that EVERYONE knew she needed to be proped up to maintain normal breathing.
I was told she stopped breathing . the DR who was called did open heart massage and after 20 min got a steady heart beat. I was notified at 2am that morning of a "problem" I was forced to wake my sons and be there as thier mother slipped into a 6 month coma. The story that I received from the Hospital, Robert Wood Johnson, in NJ was that they weren't sure what happened. I know that when I left her at 6pm that day she was awake and able to take steps. How clear is it that NO ONE at all had the fortitude to admit they made a mistake that eventually cost her her life. Even better is the fact that the records of the incident werte unavailable for DAYs. So when one looks at a Dr , keep in mind that they are no more than a person that doesnt want to take blame. Sometime we make mistakes and we should answer for them. I think my children are hardened by this experience ,Thier mom was dead and nothinghappened to cause it. the excuse didnt fly with my 16 year old.
I think in general doctors make all attempts towards the well being of their patients as far as patient care is concerned.

As regards to information disclosure I feel the system constraints, potential of probable and frivolous lawsuits and the whole health care system and it's inherent problems make the doctors very selective in what information they want to share.

The whole health care system needs an overhaul if we want to see a better exchange of information that can cater to the interests of both the patients and doctors.
As a patient you have every right to ask questions of the Dr., look at your medical record, ask for changes to be made if you disagree, get a second opinion, etc. Don't just let the medical field do what they think is best for you, get involved in your own health care. This may not eliminate mistakes but you probably can get a better answer if you ask why later.
Yes, people are litigation-happy these days. But those people are probably going to sue you whether you admit your mistakes or not. People have this nasty tendency to notice when something's not going right in their bodies. But for those of us with a bit more sense and discretion, we're probably a lot less likely to call a lawyer on somebody who's willed to say "sorry, I messed up" instead of trying to cover up the whole thing and pretend everything's fine.
It's been my experience that not only will doctors "cover" some mistakes, some will even "fudge" the truth of the circumstances to coerce the patient into going along with a certain course of action, more convenient for them, that may NOT be medically necessary at the time.

Doctors, especially OBs, are KNOWN to give patients misleading information, or to prescribe unecessary interventions in order to "get things over with" and to speed things along instead of waiting for nature to take its course. I'm not talking about real medical emergencies here - I totally believe in true rescue cesareans.

I'm talking about hospitals that hook up the IV's with pitocin & push the epidurals the moment any laboring woman walks thru the door, regardless of whether she needs it. I'm not making this up, either. My sister is a Resident, and she said when she was on her OB rotation, she was appalled at the number of interventions done for the convenience of the staff rather than for the mother/baby's direct benefit.

Then, what happens more often than not is baby is crammed down the birth canal much too fast, mom is paralyzed from the waist down and can't move as nature intended to help baby come down, baby's heart rate plummets, labor stalls, and "oh gee" time for the c-section (good, I'll be home in time for Gilmore Girls).

This exact thing happened to me with my first daughter. I was told I had a 'small pelvis' after a c-sect for stalled labor, and would never deliver vaginally. I got a post op report, and she had written "VBAC not recommended due to narrow pelvis". Explain to me, then, how I had an intervention free, textbook vaginal delivery with baby #2, and only pushed for 45 min, and baby came out quickly and easily with no tears? Same size as baby #1, too. "Too small" pelvis my hind end.

Turns out after a second opinion, what most likely caused #1 to get stuck was that her head was turned sideways. If that had been caught earlier (delivering OB never even examined me once, only nurses), there was tons that could have been done to avoid a trip to the ER. But all I hear is that "baby is OK, I should just shut up about it". No way. My doctor LIED to me and was DELIBERATELY misleading. That is NOT OK.
I lost my 4-year-old son to a preventable medical error. What was even worse than the actual error? The providers doing all they could to cover up their mistake.

We all make mistakes, we're all human. But medical providers who actively cover up their mistakes or don't disclose them in order to avoid the consequences of their mistakes are dangers to society. They're capable of anything if they're willing to put their own self interests above those of the patients they treat.
First and foremost, for those of you who question my background, please feel free to call the Admissions office at MSU-CHM and talk to them about my involvement in the Leadership in Medicine for the Underserved program for which I am enrolled in. Ask them about my dedication towards serving African-American and Latino-Hispanic communities let alone all of America's uninsured whom I'm passionate about reaching out to.

Unpleasantries aside, I fully understand the complications and issues of patients in their personal experiences with physicians. Call it naivete, but my hopes as a future physician will be to provide that trust and compassion by empowering patients with choice while being very honest and methodical about what is said and what I do. Dig within your own hearts and question whether you, are capable of accepting and appreciating honesty when physician provides such.

And lastly, judge physicians for their competence, capability and compassion under the perspective that they are indeed human beings and experts within Western medicine that is not as almighty as we think it to be.

Melvin Ku
-current UCLA graduate student in Physiological Science
-future MSU-CHM medical student entering this Fall 2007
It's interesting how the PATIENTS don't want to take the responsibility for their illness. Is it the physician's fault they needed a CABG or steroid injection or didn't control their diabetes? How is a patient's idiosyncratic reaction to a procedure or medicine (such as developing a hematoma, coagulation disorder, allergic reaction, etc) the fault of the doctor?

There is something called INFORMED CONSENT. If you don't know there are risks involved in a surgery then it's time to return to middle school.
I completely disagree with Melvin. We are more often treacherous through weakness than through calculation. Melvin's vigorous defense of physicians makes me wonder whether MSU made a mistake in its decisions this year. Only that in you which is me can hear what I'm saying. You see Melvin....listing your resume does not help you in justifying your point.
You must understand that truth begins in lies. Melvin hopefully you will learn that the world is not perfect as you imagine it. Patients lie and doctors lie.
Who is more foolish, the child afraid of the dark or the man afraid of the light?
There has to be away to stop cover-ups from happening. A system has to be set up so that records cannot be falsified, or blood test results hid from patients and their families. Many people have lost trust in the medical community.
When I was ten, I had a fairly chubby doctor who was 38 (I will leave the name out in order to protect the innocent) that did surgery on my abdomen (It was supposed to be 2 hoursor less, but turned out to be much longer). To make the long story short, his error caused many more operations and a 40+ week hospital stay (Didn't help that I had cancer in the abdomen along the way). The thing that did not make us sue was the fact that he was honest and he came out and said that he made a mistake. He told us what had happened, and was willing to do anything for us. I really appreciated his honesty. He covered us like no other, and he apologized to my family and I, over and over. I find it sad that other doctors are dishonest, and try to cover up, leaving the patient out to dry. We would have most likely sued if he was dishonest, mostly because he would be so dishonest. I guess I was one of the lucky ones to have an honest doctor.
I would just like to add my view on "informed consent". I had a TAH in Oct last year in which it was found my uterus and bladder were adhered. Post operatively I suffered severe pain (which I was told was wind and to stop whining) and blood with clots in the catheter bag. I also told them I felt that I was leaking urine but was told it was my imagination. I was dischaged on day 3 being told to come back for catheter removal was the urine was clear. I was later diagnosed with a 2cm VVF. My question is is it fair to put a hole in the bladder and not to recognise it and repair it. One would think with the bladder and uterus being adhered there should have been a heightened awareness that my bladder would injured? I have had to have two major repair operations the last of which I had 68 staples for and I still have bladder spasms. I have been off work for over a year for what I believed would be a routine hysterectomy.
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