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What Do I Do If I Make A Medical Error?

Discussion in 'General Discussion' started by Mahmoud Abudeif, Jul 30, 2021.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    Medical errors don’t just happen: They happen so often that a famous BMJ study estimated they are the third leading cause of non-disease-related deaths in the United States.

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    But patients aren’t the only victims. The shame, guilt, and consequences can hurt physicians as well, deteriorating their mental health, compromising their confidence, and affecting the quality of care they provide. And let’s not forget that errors can result in malpractice litigation.

    As long as there are humans providing healthcare, they will err. What matters most after a medical error is how the clinical team responds. Here is what the experts say you should do after you have committed a medical error.

    Be transparent

    The worst thing a doctor can do is to try to ignore or deny the error. Clinicians must report the situation through the proper internal channels as soon as it is detected. This creates accountability and allows employers to trigger relevant internal or legal processes to improve patient outcomes and help mitigate legal risk. Read about how to avoid malpractice litigation on our blog, PhysicianSense.

    In addition to reporting internally, providers must be equally forthcoming with patients and their families as soon as the situation is well-understood. They must remain informed, with the utmost transparency, about anything that has altered their or their loved one’s course of care.

    But that can be easier said than done. Despite the prevalence of medical mistakes, doctors have a “complex relationship” with error, according to Sharon F. McGhee, MD, PhD, an oncologist who has served on the American Society of Clinical Oncology’s Professional Development Committee. “This may stem from the Hippocratic oath we pledge in the early days of our training, ‘First do no harm’—a noble mantra that can set us up for a failure that we can find hard to accept,” she wrote in an article for ASCO Connection.

    McGhee suggests that the SPIKES protocol—a six-step process based on “setting, perceptions, invitation, knowledge, and emotions”—can be a useful tool in determining how to break bad news to the patient.

    McGhee also notes that many jurisdictions have “I’m sorry” legislation that protects providers from lawsuits if they apologize—further underscoring the need to be clear, concise, and timely when informing patients about errors.

    Be empathetic

    When communicating with patients and their families about a medical error you or your team committed, it is important to take responsibility and express sincere remorse for the error.

    According to Robert D. Truog, MD, director of Harvard Medical School’s Center for Bioethics, these conversations are not supposed to be easy—and they are full of potential pitfalls.

    “Full disclosure and apology is the right thing to do. It just needs to be done well,” he told the Association of American Medical Colleges. That includes not just apologizing but explaining why the error occurred if it’s known and assuming responsibility.

    Ultimately, fear of litigation or consequences should not create a silence that hinders patient care. A recent Stanford University study published in Health Affairs found that adherence to an investigational post-medical error protocol based around full disclosure, apology, and resolution did not increase the risk of litigation. An apology, the authors concluded, seems unlikely to backfire.

    Forgive yourself

    The patient isn’t the only person who requires empathy after a medical error. To move forward and continue providing high-quality care, providers who committed the error must forgive themselves.

    Researchers from the University of Virginia School of Medicine, University of Florida, and Harvard Medical School in Boston interviewed 61 doctors who had made serious medical errors. The team’s report, published in Academic Medicine, detailed characteristics and practices that helped doctors after their mistakes. They found that having a strong moral context, the ability to communicate with peers, and a willingness to forgive oneself were key to avoiding negative professional outcomes.

    To forgive themselves, physicians are well-served by leaning on peers. The authors wrote that discussing medical errors among their colleagues allows doctors to realize that other very good practitioners have also made unfortunate, or even similar, mistakes. That context allows doctors a stronger basis to accept their situation and grow from it.

    Learn from the mistakes

    The best outcome from a medical error is no patient harm. The next-best outcome is a future error averted. Experts indicate that, along with transparency and forgiveness, learning is an essential pillar of any clinician’s response to their medical error.

    If doctors have already been thoroughly transparent throughout the reporting process, they will likely have a detailed understanding of what caused the error, whether it was a lapse in judgment, a bad habit, or a gap in knowledge. Just as they would while treating a patient, they can begin to address the underlying causes of these traumatic events to mitigate them in the future.

    That learning process can also be part of the coping process for a physician who committed the error, a means of restoring confidence and pride in their work by focusing on improvement. Pamela Wible, MD, wrote on KevinMD that doctors should consider this a way to “honor [their] patient by learning how to prevent future errors.”

    Wible also encourages doctors to go beyond just correcting the mistake for themselves—she believes it’s important to then share that new knowledge with peers, and to reframe the situation from a personal failure to an opportunity for collective growth and improvements in care.

    Work toward a new culture of transparency

    Healthcare is getting a better grasp on the cultural changes it must make in order to avoid medical errors. That begins with addressing physician burnout.

    According to a study published in the Western Journal of Emerging Medicine, traumatic events like medical errors often lead to “second victim syndrome” (SVS), in which guilt and stress hamper a physician’s personal and professional life to the point of burnout and major risk. The study noted that, in 2018, as many as 6,000 emergency physicians had contemplated suicide.

    The authors wrote that society “often sets a zero-mistake standard for physicians,” which can be difficult for clinicians to set aside when coping with an error. They also pointed out that previous research suggests system failures are just as often to blame for medical errors as individual actions.

    To diminish medical errors and mitigate risk of becoming a “second victim,” after an error occurs, clinicians must work with their peers in their health system to create an internal culture of support and transparency.

    Healthcare knows that prevention is the best medicine. Fight burnout and increasing communication are fundamental to preventing future errors.

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