Early in life most of us are taught to tell the truth. Its corollary is to admit when you’ve made a mistake.
In the world of medical malpractice, however, these simple life lessons are complicated. One reason is because confidence-and, often, its uglier relation, arrogance-is characteristic of many good doctors. Arrogant doctors don’t want to admit when they’re wrong; indeed, many don’t even recognize it.
But a big reason for a medical professional’s inability to admit making a mistake is concern over being sued. Patients, that thinking goes, have a stronger lawsuit if you’ve admitted that you erred instead of remaining silent and forcing them to prove it.
There’s lots of evidence to suggest that attitude is more bone-headed than wise; we reported a study that concluded that patients are less likely to sue when hospitals are honest in copping to their mistakes. A recent post on the KevinMD blog speaks to that situation.
Former hospital CEO Dr. Paul Levy addresses the issue as a matter of leadership. He talks about a creating a culture of honesty that is good not only for the medical professionals who work there, but good for the patients who depend on their care.
Medical leaders, Levy says, “must do everything [they] can to encourage people to admit mistakes they have made and to call out problems they have found in the organization. If people think they will get in trouble for having erred, or for having brought up a systemic problem in the organization, those errors and problems will go unreported. The person and the organization will thereby lose an opportunity to grow and improve. Accordingly, a strong commitment not only to transparency but to a just culture is essential to achieve continuous improvement.”
A patient was admitted to his former hospital for surgery on her left ankle. When she woke up in the recovery room, imagine her surprise at finding her right ankle bandaged.
The surgeon had operated on the wrong limb.
He immediately notified his superiors, including Levy. The quality assurance staff reviewed the mistake, and decided unanimously to publicize it throughout the hospital. The point was to teach lessons about pre-operative procedures, and to ensure that such grievous harm would not happen to any future patients.
Levy also blogged about the incident, he says, “in the hope that our experience might be of value to workers in other hospitals.”
Many hospital staffers, Levy reported, wanted to know if the surgeon would be punished, and were surprised when he said “no.”
The surgeon had been punished enough, Levy believed. The surgical team, he said, was “devastated by their error and by the realization that they had participated in an event that unnecessarily hurt a patient.”
It was sufficient, Levy believed, that the responsible parties had reported the error promptly, had disclosed it to the patient and apologized and had participated honestly in the case review.
Comments following Levy’s blog were less charitable than he was. Most commenters believed there should have been consequences beyond a deep sense of regret. One person wanted to know:
- Did the patient’s insurance company pay the erring surgeon?
- Who paid the anesthesiologist, hospital facilities/supplies and support staff’s bills incurred during the incorrect surgery?
- Who paid the co-payments for office visits before and following the incorrect surgery?
These are fair concerns, but no one in Levy’s story necessarily is absolved from taking responsibility for the cost of the error. We’re looking at the bigger picture here, at the establishment of a cultural default of admitting errors promptly and accepting responsibility for them.
Like the commenters, hospital trustees grappled with the notion of punishment. One supported Levy’s actions, another said that the surgeon should have known better. “Wouldn’t someone in another field be disciplined for an equivalent error?” he had asked.
Levy says he initially over-emphasized the wrong point, the doctor’s sense of regret. “The head of our faculty practice,” he wrote, “put it better than I had, ‘If our goal is to reduce the likelihood of this kind of error in the future, the probability of achieving that is much greater if these staff members are not punished than if they are.'”
The goal of patients, advocates and caregivers should be the same: learn from an error, and reduce its incidence going forward. A kindergartner understands that.