Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, vomiting and dizziness prompting an urgent 911 call.
Where she thought her symptoms were attributable to bad heartburn, the studies at her local hospital demonstrated otherwise: She was found to have severe disease in all of the major oxygen-carrying vessels that supplies her heart and was at a high risk for a fatal heart attack without surgical intervention.
While caring for Ms. A overnight, I made the incorrect decision to administer a cardiac medication to treat her disease that is known to increase the risk of bleeding during surgery. Given her need for the operation, the benefit of providing this medication to safely temporize her heart condition in the short term did not outweigh the risk of delaying the intervention that she ultimately needed. Despite the standard of care regarding this clinical scenario, I made the wrong call.
The Background
Making a medical error is the most feared consequence of practicing medicine. From misreading lab values to doing surgery on the wrong site, any slip in clinical judgment can potentially cause serious injury or even death. A landmark study conducted by the Institute of Medicine (IOM) demonstrated that medical errors in the U.S resulted around 75,000 unnecessary deaths and more than one million excess injuries each year.[1] Despite this data, it is remarkable that medical errors are made every day and usually result in little to no negative patient outcomes.
Whether one is just starting out as a physician in medical training or is a leader in their respective field, all medical providers will make mistakes during their careers. Given the fact that this is an unavoidable facet to making thousands of clinical decisions each year, how does one appropriately deal with such errors?
Unfortunately, many practitioners choose not to deal with medical mistakes at all. In a study surveying the prevalence of non-disclosed medical errors, Taylor et al. found that more than 30 percent of physicians and nurses underreported almost half of medical decisions that they perceived as clinical oversights.[2] Not only is this blaringly unethical, but also limits the medical community from creating stopgaps to avoid such errors in the future.
The Solution
There are several steps to appropriately dealing with a medical error that are relatively straightforward:
1. Let the patient and family know.
Many health care providers fear that notifying patients of an error will decrease rapport and put them at a higher risk for receiving malpractice lawsuits. Interestingly, a report by Boothman et al. from the University of Michigan demonstrates otherwise. The more that patients and their families are notified of serious mistakes, the less they are inclined to reactively sue.[3]
Regardless of the tangible consequence of making a medical error, practitioners have the ethical duty to let their patients know of any significant clinical oversights.
2. Notify the rest of the care team.
Alerting the rest of a patient's care team of a medical error is not easy. It essentially demonstrates one's fallibility to his or her colleagues and may result in considerable changes to the predetermined patient-care plan. Despite this, these errors must be relayed to the rest of the care team in order to better handle any immediate significant negative patient outcomes and reduce further mismanagement from occurring.
3. Document the error and report it to the hospital-safety committee.
In order to avoid further complications to a patient's care, it is essential that the medical error be appropriately documented and reported. By doing so, it avoids further complications by independent health care providers who also assume care of the patient and can globally increase patient well-being by improving hospital-wide safety measures.
The Take-Home Point
Committing and dealing with a medical error is one of the more humbling experiences in the field of medicine.
Given the fact that making clinical errors in judgment is an inevitable aspect to clinical practice, it is imperative that practitioners of all levels of training be aware and comfortable in appropriately handling such events.
* The patient's demographic information in this article was changed to protect identity and assure anonymity.
References:
1. Kohn L T, Corrigan J M, Donaldson MS (Institute of Medicine) To err is human: building a safer health system. Washington, DC: National Academy Press, 2000.
2. Taylor JA, Brownstein D, Christakis DA, et al. Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Pediatrics. 2004 Sep;114(3):729-35.
3. Boothman RC, Blackwell AC, Campbell DA, et al. A better approach to medical malpractice claims? The University of Michigan experience. J Health Life Sci Law. 2009 Jan;2(2):125-59.
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