Monday, October 29, 2007

Medical Error : The Human Dimension (article in New England Journal of Medicine)

The October 25 issue of New England Journal of Medicine had an intriguing article entitled “Guilty, Afraid, and Alone — Struggling with Medical Error. This article was also covered by the New York Times. It focuses on the need to address the emotional repercussions of medical error, not just correct error rates. It’s not surprising that doctors who make treatment errors feel guilty, may fear a law suit, and therefore tend to do the exact opposite of what the patient and family need – they avoid the person and their own accountability and abandon the family when it is most in need of attention.

Families, including partners of the patient tend to feel equally guilty or even guiltier – for not keeping close enough watch on the patient. They also fear further harm from medical staff if they ask questions about mistakes.

Silence begets silence and breeds mistrust. And once mistrust enters into the family/medical system relationship, remediation and reconciliation move farther and farther away.

The article says that apology and disclosure are necessary but may be insufficient. It concludes with: “Perhaps most important, building bridges to injured patients necessitates including them and other patients in the development of solutions.”

I wonder if medical professionals know how very hard it is for patients to challenge them on any point. When was the last time you said, “No!” to your doctor? I was only able to reject a surprise spinal tap because Richard was in the room with me and saw my ambivalence and suggested we postpone. A friend, who is a medical journalist, could barely fend off a posse of young neurologists who wanted to insert wires into her heart to shoot it with electrical current to clear possible clogs. Her husband blocked and tackled for her too.

Yes doctors who make mistakes need to ‘fess up and apologize. But I think patients and their partners can help each other enormously if they can stand side by side and ask tough questions and say, “No” or “Not now” or “Are you sure? Can you please check again?” or “Why do you think this will help? And what is the down-side?” or “What if we waited?” or “How many times have you done this procedure?”

Have you said, "No" to your doctor? What did it take to do that? And what happened?

1 comment:

Paul Levy said...

Not totally related to this, but please check out Grand Rounds today at http://runningahospital.blogspot.com/2007/10/grand-rounds-volume-4-number-6.html. Some moving and insightful stories about experiences in hospitals, including one from Barbara! Thanks.