The Pain of Medical Error: Not Just Physical

Guilt, fear, and further isolation plague families of victims of medical error, says the New England Journal of Medicine.

Why guilt? Because families feel like they should have kept a closer watch on their loved one, and regret the trust they placed in the health care institution or its workers. This guilt persists even if the family took reasonable precautions–for instance, the authors of the article discuss a case where a patient was given morphine and died of kidney failure despite the fact that his family repeatedly told doctors and nurses that he had sickle cell anemia. The family often feels inadequate for being unable to watch the patient twenty-four hours a day.

They also feel fear: fear of retribution, fear that health care workers will neglect or compromise their loved one’s care if they make some sort of formal complaint. This is particularly true of people in disadvantaged and disempowered sections of society.

Their emotional turmoil is often compounded by the reactions of the health care workers, who will often isolate the patient’s family after realizing their error. This leads to further pain and may even lead to further medical mistakes:

Guilt persists in the daughter of a woman who died after a series of errors culminating in a missed case of pneumonia. Although the daughter is a nurse, she could not gain entry into her mother’s circle of clinicians, who closed ranks after the errors occurred. “The nurses were ruder to me than you can ever imagine, and the doctors wouldn’t tell me anything,” she said. “They looked at me like I was a dumb little girl. I became so addled that I couldn’t act decisively and get her out of there to another hospital. I’ll never get over my guilt.”

This isolation comes at a time when, as the authors point out, patients most need someone to communicate with them on a personal and human level. They suggest that honest, direct communication–without condescension, buck-passing or hedging around to avoid lawsuits–is the best way to keep the patient safe as well as feeling satisfied with the care he or she has received.

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