A friend of mine was diagnosed with an early stage of cancer and came to the hospital in which I work for a surgical procedure. I sat with her as she was coming out of anesthesia. She complained about the delay in the next dose of her pain medication. She cried a little, scared about what was happening to her. She didn't fully understand the treatment her doctor had prescribed. I stroked her hand and listened. Nothing out of the ordinary happened during her hospital stay. She was discharged and is recovering nicely. However, 100,000 patients in the United States each year wake up to learn that they have been the unintended victim of a medical error. Some of them don't wake up at all.
Medical errors fundamentally upset the balance of how health care is supposed to go. Physicians and other health care professionals are supposed to get it right. Patients are supposed to get better because of the treatment they receive. In these cases, the fundamental rule of medicine -- "First, do no harm" -- is broken.
Hospitals have a series of checks and balances in place to prevent as many medical errors from happening as possible. Most of the time, procedural steps like asking a patient's birthdate to confirm her identity, dispensing medications in a systematized, controlled way, and writing the surgeon's initials on the body part of the correct surgical site work well. But in rare instances, the circumstances and actions of health care providers line up in such a way that medical errors occur.
I have spoken to many patients about what should happen after a medical error occurs, and subsequently published about it. Patients have told me that they want clear and open communication from their providers about exactly what happened; how any harm will be corrected; and reassurance that steps have been taken so that this won't happen to anyone else. As a healthcare system, we must work quickly to support a patient's physical and emotional needs after a medical error occurs and to keep the channels of communication open.
But there are other victims of medical errors, and one of them is Dr. Brian Goldman. There are many physicians and health care professionals who go to work every day committed to helping patients and who, one day, inadvertently miss something. My colleagues and I surveyed over 3,000 physicians to learn how being involved with medical errors affected them. Their answers echo Dr. Goldman's experiences: over 40 percent said that they were more anxious, less confident, and had trouble sleeping afterwards. They were concerned about losing their job, being sued, being judged by their colleagues, and making the same mistake or a different one again. They were extremely self-critical, even unforgiving, of their performance as doctors. Only 10 percent felt that they had received the support they needed from their health care organizations to cope with error-related stress.
Dr. Goldman generously shared his firsthand experiences with errors so that the perfectionist culture of medicine could be transformed into one that is willing to be open about and learn from its mistakes. If Dr. Goldman's vision is to be realized, how could we move forward? How do we reconcile our commitment to excellence in health care with the inevitability of medical errors? How can we be comforted while accepting our fallibility as humans? The words of Voltaire -- "Perfection is the enemy of the good" -- point to one possibility.
I work at Washington University School of Medicine and Barnes-Jewish Hospital, one of the best medical schools and hospitals in the country. While I am not a physician, for the last decade I have observed some of the nation's best-trained physicians and health care professionals as they serve their patients. I trust these physicians, not because they are perfect, but because they are smart, committed, and conscientious. I am also assured by the health care quality teams across the country working hard to immediately determine the root causes of errors and make adjustments as quickly as possible so no other patients are affected in the same way.
I have also seen physicians' genius and kindness up close. I have seen a surgeon sew a kidney donated from a mother into her son. Within minutes it filled with blood and began making urine, making possible a new future for a young man. Another physician told me about how he stops everything and just sits with a patient if he knows the patient will not survive. I picture him, exhausted by his best efforts, but still holding vigil in a darkened room. He believes that no one should die alone. Nor should physicians feel alone when questioning themselves after an error.
We need to better honor the stewards of our care. We need to thank them for trying to do the impossible every day, knowing that on occasion, mistakes will occur. We need to allow them to be human, to be redefined physicians who learn and grow from errors rather than being destroyed by them. Let's not let the pursuit of perfection get in the way of the good.
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