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faking perfectionism

Discussion in 'Pre-Medical - MD' started by silas2642, Dec 3, 2005.

  1. silas2642

    silas2642 silas2642
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    I work as tech in a local hospital, screwed up a little (and my mistake in no way affected the patient's health), and apologized to the patient for my mistake. The doctor on took me aside and told me that we should never apologize for having done something wrong, that we should always act "professional" in the sense that we never make mistakes, because the patient could always take their business elsewhere.

    So I went home and cried. I can't believe this is the world I'm working so hard to enter sometimes. I want an honest relationship with my patients and I want them to know that I will always give 100% to give them the best care possible, but I also want them to realize that I'm human, my colleagues are human, and everyone working in the hospital is human, and so we make mistakes. I think that by faking this sense that we are perfect and always right (and if we haven't yet faked competence, you will on your first day of internship) we set up ourselves up to not only fail but fail miserably. Our patients hate us and resent us for not telling them that we may have made a mistakes, and then they really don't trust us.

    I know that as a patient and family member of patients, I really appreciate it when someone in the healthcare field says, "I made a mistake, I'm sorry" or something along those lines when he was wrong. To me it shows that the person realized their mistake, is sorry for it, and will work hard to correct it.

    It really bothers me that so many doctors and healthcare professionals put the hospital they work for in front of the needs of a patient. I guess I'm living under the illusion that as physicians we should ask ourselves, "what's best for the patient" when making our decisions, rather than "what is best for this corporation." Any other thoughts?
     
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  3. anystream

    anystream Senior Member
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    I think you're right. You might be interested in reading this:

    http://tennessean.com/apps/pbcs.dll/article?AID=/20050625/OPINION03/506250352/1007/ARCHIVES

    Anyway, I had a interview question that revolved around this. I answered that I would apologize to the patient and be honest with them, and I got into that school...so maybe not everyone is as jaded as the doctor you worked with. It sounds like he doesn't want to undermine his own power at the risk of not taking the best care of his patients- not cool.
     
  4. nimotsu

    nimotsu 荷物
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    it's not about professionalism but rather liability and neglience. If you apologize, then you admit neglience. It's not medicine's fault.. Americans just have an ambivalent attitude toward responsibility due to increased litigation, and one minor mistake can turn out to be a payload for some liberal pro-bono lawyer who wants to "help" out or some trashy lawyer who wants to turn a profit.
     
  5. letmein!please?

    letmein!please? Senior Member
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    If someone asked me that question I would say, "I do not compute..I make no mistakes". :laugh: But seriously, I think it depends on the mistake you make. Some are obviously better to keep secret than others, and if the patient kows you made one, I think its better to be honest than be an ass about it. Of course, avoiding lawsuits is a good thing too.
     
  6. Saluki

    Saluki 1K Member
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    I got an interesting perspective on apologizing by the head of the claims department of a major trucking company. He told me that they always said him to talk with a family after a major accident. He tells them he's sorry that it happened and offers to help them get on their feet and if it was obvious it was their fault he goes ahead and admits that and apologizes right off. He says that not only is it the ethical thing to do but it's also good business sense. People are less likely to sue if they feel that the other party is willing to admit they're in the wrong and make amends....
     
  7. risnwb

    risnwb Member
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    I agree that you should put the needs of your patients in front of the needs of whichever hospital you are working for. However in this case where your mistake did not affect the patient’s health, I see no reason to let them know that you made a mistake. While being honest is always important, I think its also important for your patients to trust that you are a competent healthcare provider, and so sometimes this might mean that you don't disclose certain things. This doesn’t mean that I think any physician should lie to their patients... maybe just fudge sometimes to make them feel more secure. There are plenty of other ways to relate to a patient and help them understand that you are human and care about them. I guess the least of my worries would be a patient taking their business elsewhere... there will always be more sick people to take care of!
     
  8. silas2642

    silas2642 silas2642
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    The mistake I made, there is no way anyone could have sued for it. I simply told the guy he was having a different test than was actually ordered and called in a poor nuclear technician that didn't have to be there. It's a long story, and kinda confusing, so I won't go into detail unless someone wants me to. The "mistake" he was mad about is that I admitted that I explained the wrong test to the patient... God forbid!!

    Hospitals are one of the most dangerous places to be in, thousands of people die each year because we screw up. I don't think that it helps anyone, patient, doctor, or hospital, to try and pretend that everything is great, that we never make mistakes, and always know exactly what we're doing.

    Patch Adams has a sign up in the Gesundheit Institute that reads something like, "please be patient with us, we're trying our very best, but realize that we are human and do make mistakes." This is also a hospital that doesn't carry malpractice insurance, puts its patients first, and seems to do extremely well not getting sued as well as healing sick people. It shows to me that it is completely possible to be totally honest with your patients without getting your ass dragged to court.
     
  9. tulane06

    tulane06 Private Joker
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    There was a great article in the New York Times health section a few months back that discusses the issue you brought up. I will try to find the link for you.
     
  10. gonadotropins

    gonadotropins Member
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    Wait a second... the hospital has no malpractice insurance? That seems strange. Can you explain why that is?
     
  11. silas2642

    silas2642 silas2642
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    Patch Adams doesn't believe in it; it takes away from patient care. Read his book, Gesundheit!
     
  12. Anastasis

    Anastasis caffeinated for safety
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    That's such a great book! Part of what made me want to be a doctor!
     
  13. Shredder

    Shredder User
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    silas, isnt that a guys name? first of all you cried? secondly, you admitted to it? tsk, so much for machismo.

    anyway i agree with the doc. you cant reveal weaknesses to clients, it detracts from the image. if you dont fake it other doctors will. i respect your sincerity but i think this also applies to apps and interviews. you do what you have to do to win, 100% honesty is just not the best policy in the real world.

    i think its similar to the student who tells the teacher that he got too many points on a test. you take a little here you lose a little there, it evens out in the end.
     
  14. ClearDay

    ClearDay Senior Member
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    I understand your frustration, but like other posts before me, I think this rule applies to all profession. If the mistake doesn't affect patient care, why would you tell them - and why would they even care? I mean, would you tell your patient that you mis-spell a word in their chart and then correct it? It's about knowing what action is appropriate at what time. Just my 2 cents.
     
  15. ShyRem

    ShyRem I need more coffee.
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    In Denver a few years ago, something went wrong in a routine surgery on a child. The physician injected the wrong medication and the child died. When the surgeon found out what went wrong, he immediately went out to the family, explained the mistake, and apologized (hospital policy at the time had medications poured into cups - the meds looked alike, the cups were not clearly labeled, and the wrong med was drawn up). The hospital was appalled that the doc would actually ADMIT fault and apologize.. but the parents, although grief-stricken, appreciated the honesty so much they refused to sue. The hospital offered a settlement for something like $250K which the family immediately donated to charity. True story.

    I think an apology is the very least that can be done for an error. When we give the impression of perfection, it is easier for the public to sue because they expect perfection.
     
  16. Psycho Doctor

    Psycho Doctor *** Angel
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    I think you did the right thing; honesty is always the best policy. Be proud and confident in your self tha tyou are honest and hav eintegrity.

    I would worry about any doctor or anyone else that can't admit and apologize for a mistake. he could instead cover up a mistake which could be detrimental to a patient's well-being and jeopordize hsi health...all to appear better. :(
     
  17. Psycho Doctor

    Psycho Doctor *** Angel
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    so sorry about the child but that's a great doctor to admit his mistake and an absolutely amazing family.
     
  18. Songeur

    Songeur Junior Member
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    I also work as a tach in a hospital. Let me get this straight...you accidently told a pt that they were going to have a different test than the one ordered and called in a nuc med person that didn't have to be there, then apologized to the pt for the confusion, right? I don't see that you were wrong in admitting what happened and apologizing at all. The pt was probably wondering what happened. It doesn't sound like it warranted being pulled aside by any doctor...seems to me the nuc med person would have most upset by having to come when not really needed.

    Because of my core beliefs, I do believe that honesty is the best policy, although not always the easiest one and not always the one that "gets you ahead", but the right one. I'm proud of you. I, too, encounter a lot of cya around here that does not always put the pt's needs first. It's wrong...and I don't want to ever be accused of it.

    Hang in there!
     
  19. Shredder

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    my brothers a doc and hes said that an unsaid rule among medical professionals is that you never volunteer information like that to those outside the loop. you only tell what is asked for, that is when the honesty begins. withholding potentially damaging information is not dishonest. its a gray area, but those are just the rules of the house. if one blabs about every mishap that goes on behind the scenes, it could lead to lawsuits left and right and it will certainly earn him a poor reputation among colleagues. a tattletale, sort of. every doc will mess up at some point, and you wouldnt want anyone tattling on you for honest mistakes. but i guess ive strayed a little from the main point.

    its kind of like what happens on the green mile, stays on the green mile. unless somebody asks.
     
  20. rpkall

    rpkall Darwin Award Winner
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    If you make a mistake, you make a mistake. But routinely admitting it can (unfortunately) get you into trouble with patients. It's a physicians responsibility to learn from every mistake in an appropriate medically-oriented forum and not make the same mistake again. That's why they have these M&M conferences. Sometimes physicians do the best they can, and patients get hurt; sometimes they make a mistake that a large percentage of similarly-trained physicians would have made in the same circumstance. Is this a punishable offense, if the doc believed he was acting in the patient's best interest at the time?

    There's a difference between making a mistake and committing malpractice. Sometimes patients and their lawyers don't see things that way, however. And I think that's what steers doctors towards this pretend perfectionism stuff. CYA (cover your a$$) is unfortunately just as important an abbreviation in hospitals as HTN or DM (hypertension, diabetes mellitus).

    As a student (or tech) it's perfectly okay to say "I don't know, but I'll find out for you." Or even: "I think the reason for that is ____ ____; but you should ask Dr. So-and-So when you see him next."

    I was always told, however, that during a procedure, when your hand slips, you're supposed to say "There," in a confident tone, and then ask for suction or gauze. Not: "Oh ****."
     
  21. silas2642

    silas2642 silas2642
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    No, I'm not a guy, I'm actually a hermaphrodite, silas is my dog's name (not too creative in the screen name department), and I think that it's very cool for guys to cry and admit they were wrong. If men did this more often, women would call them "insensitive bastards" a lot less often.

    Look, hospital mistakes kill 90,000 people A YEAR. That's three times more than suicide, and like four more times than homicide. This is an insane statistic, and I don't think that the best way to correct it is to never tell the patient that we screw up... it sets up unrealistic expectations that we're going to do everything perfectly and error isn't even on the map.

    Knowing what goes on in hospitals has me terrified of having a loved one being there-- a pre-op nurse once tried to send my mother to the wrong surgery and got in a fight with her about her own identity and what kind of surgery she was scheduled to have. This "I know what I'm doing so just let me do whatever I want to you because you really ought to trust me" attitude is not only unearned, but it's also dangerous. We get this false confidence in ourselves that we know everything, and we don't.

    Maybe I'm just way to idealistic, but maybe honesty is the best policy when dealing with people, especially sick people who are there for your help and are especially vulnerable.
     
  22. Anastasis

    Anastasis caffeinated for safety
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    GEEZ!! I'm so sorry, that must have been really scary! :(
     
  23. LaurieB

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    This is actually a major issue that is being legisated. A group of medical professionals, insurers, and lawyers are promoting apology as a way to ease our malpractice problems. If you all are interested, here are a few links to info:

    http://www.sorryworks.net/

    http://www.npr.org/templates/story/story.php?storyId=4234901

    http://www.medscape.com/viewarticle/504276 (requires login so I am pasting below)

    Apologies for Medical Errors Come With Mixed Messages

    Gwen Mayes, JD, MMSc

    Growing up in the South, I picked up a rather annoying and unnecessary habit of apologizing for everything that went wrong around me, even when I wasn't at fault. If a friend didn't have a good day at work, "I'm sorry" was all I knew to say. If my mother's favorite cake fell in the oven, "I'm sorry" was heard around the dinner table. As a child, the simple phrase "I'm sorry" wasn't so much an expression of remorse for something I did, as it was a natural reaction to feeling bad for someone when something went wrong.

    But what happens when bad things happen to good people in a hospital? Is an apology as harmless when one has made a medical error?

    In 1999, the Institute of Medicine released its report, To Err is Human , which indicated that between 44,000 and 98,000 deaths occur each year in this country as a result of medical errors. Since then, the focus on patient safety and systematic change for reducing errors in the medical arena has grown. The movement, in part, involves legislation that aims to improve communications between healthcare providers and patients in order to create a more transparent environment in which medical errors do not automatically trigger an adversarial situation.

    "I'm sorry" legislation, as is it often referred to, hopes to soften the medical malpractice divide that pits skeptical physicians and healthcare providers against plaintiff lawyers and angry patients. Although they come with different bells and whistles (eg, one bill safeguards comments made within 72 hours of a recognized error), in essence the laws shield apologies and expressions of sympathy from being introduced as evidence of liability in a medical negligence lawsuit.

    "Right now the approach to medical errors is deny and defend," says Jonathan R. Cohen, JD, Associate Professor, Levin College of Law, University of Florida, and noted expert in dispute mediation and negotiation (personal communication, Jonathan R. Cohen, April 28, 2005). "Not apologizing creates a 'Catch-22' where the physician may want to apologize, feels it is the right thing to do, but is being told by his or her insurance carrier or the hospital administrator to keep quiet. As a result, his silence causes the patient or caregiver to become angry and feel even more removed and hurt. Very little gets accomplished other than creating a standoff."

    Advocates of apology legislation draw strength from the successful full-disclosure program implemented at the Veterans Affairs Medical Center in Lexington, Kentucky. At one time, this Center had one of the highest malpractice claims totals in the VA system; now it ranks among the lowest after dramatically changing how it handled medical errors.[1] Instead of circling the wagons and keeping silent, the Center addresses the problem openly and quickly. Any patient harmed by a medical error is immediately informed of what happened and offered an apology by the chief of staff. If the risk management team determines the hospital or a staff member is at fault, a fair settlement offer is made.

    continued on next post...
     
  24. LaurieB

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    "Apologies for medical errors get us to a better place," says Kathryn Wire, JD, MBA, President, Kathryn Wire Risk Strategies, St. Louis, Missouri, a former practicing medical malpractice attorney with more than 20 years of experience in healthcare risk management (personal communication, Kathryn K. Wire, Principal, Kathryn Wire Risk Strategies; April 27, 2005). "Although the JCAHO [Joint Commission on Accreditation of Healthcare Organizations] requires that adverse events be disclosed, from a claims perspective it's still the right thing to do. Incorporating an apology into the disclosure enables the provider to establish a relationship with the family and patient in order to move forward in a way that hopefully will avoid litigation."

    More often than not, not apologizing adds fuel to the fire. Patients feel overlooked and disconnected from providers and a healthcare system that at a prior point welcomed them in the door. Once an error is made, communications seem to cease. "At some point, any road you take is going to be difficult, but not apologizing can be extremely irritating and annoying to the patient and family," says Cohen. Even if a suit can't be avoided, apologies can reduce the animosity enough to reach a settlement sooner, Cohen adds.

    Amid the passage of several state "I'm sorry" laws, a new national coalition has emerged advocating a formal apology for medical errors as a possible solution to the medical malpractice debate.[2] The group, "The Sorry Works! Coalition," includes a diverse mix of doctors, lawyers, insurers, patients, and concerned citizens who work with legislatures, policy experts, the media, and lawyers on both sides of the table to advocate for full-disclosure of medical errors. Founded by Doug Wojcieszak, a political consultant and the brother of a 39-year-old man who died of massive myocardial infarctions as the result of a "gross medical error," the Coalition pushes a transparent process in which providers consciously address medical errors openly when possible.

    "We're not opposed to the 'I'm sorry' laws, it's just that the Coalition advocates a much broader approach," says Wojcieszak (personal communication, Doug Wojcieszak, April 28, 2005). "After a bad outcome, the physicians and hospitals first do a root cause analysis as quickly as possible. If there's been an error on the part of the hospital or one of its staff, then the authorities should apologize and immediately begin the process of discussing a settlement. But if there's been no deviation of the standard of care, no negligence, then the hospital personnel should sit down with the family, until they are blue in the face if necessary, and open the charts and explain to the patient and the family exactly what happened and why."

    Wojcieszak fiercely encourages this attentive, immediate response on the part of the hospital, citing his own experience as "just horrible." "While my brother was dying on the operating table, his doctor came out, took one look at my mother in the hall and ran, literally ran, the other way."

    According to Wire, risk managers and administrators should be ready to talk settlement early on. "There's no need to wait, but often times the process isn't very transparent and the hospital wants to hold off talking to the family about a settlement until after the defense lawyers have been called in, some depositions have been taken and the medical experts have weighed in. My question to them is, 'what are you going to learn?" says Wire. "It's the same thing with insurance companies. They very often just don't want to move along, and this perpetual silence can add to the problem. In the short run, the cost of settlements may rise, but in the long run you hopefully lower the cost of litigation."

    From the little bit of evidence available from the VA Medical Center, apologies seem to lead to a more amicable settlement. "In addition, they begin to change the healthcare culture to one that is more transparent," says Cohen. "While we really don't know at this point if these laws are effective, there is some potential for good and we should wait and see what this legislation produces." Part of Cohen's fence riding comes from his concerns that the laws will backhandedly promote insincere apologies. "Under the old system, if a physician knew that his apology could be used as evidence at trial, there would be a certain cost, a certain weight, to the apology and we would probably consider it more sincere. With these new laws, if a physician knows an expression of sympathy cannot be used, the apology might be more contrived or less sincere."

    Even others believe the apology legislation is perhaps unnecessary, maybe a bit of hand holding for the physicians. "I don't think these laws hurt anything," says Wire, "but I honestly question whether they add anything to the current system. They are very limited in scope." How limited depends on the state law, but for the most part the immunity only covers expressions of benevolence and sympathy, not apologies that come with an admission of fault or guilt. Parsing one's words at a time of crisis can be difficult. While "I'm sorry this treatment isn't working" might come within the ambit of the law, "I'm sorry this treatment isn't working, but we should have started you on it sooner" might not be.

    Staunch advocates of apologies after medical errors admit, however, that there are some circumstances in which an apology isn't appropriate; or, if it is, the timing and setting have to be carefully determined. According to Cohen, an apology probably isn't appropriate if someone sincerely does not believe he has made a mistake or if she needs to wait to determine exactly what happened. "There's also many situations that are so emotionally charged that there is a real concern that the information will be misused," says Cohen. "But I feel that in even the worst situations where there has been a death, the need for an apology rises and also the sensitivity in how it is made rises as well."

    Unfortunately, comments made at the time of a medical error are often misconstrued or made in the heat of the moment. Deciphering the "he-said-she-said" comments -- sometimes years after the actual event -- is difficult if not impossible. What is certain, according to Wojcieszak, is that open communication is at the core of medical malpractice reform. "At the end of the day, the current proposals on the table for medical malpractice reform can make it a little harder for a patient to sue and a little less lucrative for the attorneys, but we run the risk of keeping the same systems in place," says Wojcieszak. "We still don't know that the same mistakes aren't being made again."

    Few dispute that apology laws are just the very tip of the iceberg in a larger effort to ease the tension between harmed patients and the healthcare system. According to Ila Rothschild, JD, healthcare consultant in Chicago and board member of the American College of Legal Medicine, the current system of liability doesn't support change because it focuses on the "sharp end of the stick" (personal communication, Ila Rothschild, JD, April 26, 2005). "Healthcare really is at a crossroads, and there must be strategies for improving and reducing liability. At the foundation is patient safety. Somehow we have got to get on the same side, and that is the side of patient safety."

    "These laws are baby steps, but steps in the right direction," says Rothschild. Although not universally endorsed, Wojcieszak claims that plaintiff's lawyers have been more receptive than defense attorneys to the work of his Coalition. "There are plenty of attorneys out there [who] don't like these laws," says Cohen. No surprise in that most defense attorneys and malpractice carriers advise physicians to refrain from talking to patients and offering explanations when an error occurs, whether it be to apologize or not. But as Rothschild reminds us, "patients know more than ever about their own healthcare, and we expect them to take some responsibility for better care. We're just beginning to see what these laws have to offer, but we must promote the systems change that will ensure patient safety, and better communication is part of it."

    The "deny and defend" culture will not be one that easily dismantles, but somewhere there's the hope that the simple act of apology will not be forgone when something terrible has gone wrong with a patient.

    References
    Prager LO. New laws let doctors say "I'm sorry" for medical mistakes. AMNews. August 21, 2000. Available at www.amednews.com .
    Press release: New national group of doctors, lawyers, and insurers advocating apologies for medical errors. Available at www.sorryworks.net .
     
  25. Law2Doc

    Law2Doc 5K+ Member
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    There's certainly evidence that those doctors who are honest with their patients get sued less. However, I suspect that when they do get sued it often becomes a slam dunk for the plaintiff, who can rely on apologetic statements as admissions of negligence. At any rate, it is the hospitals or at least the doctors call as to whether to apologize (and thus admit liability, fault, wrongdoing, failure to meet the requisite standard of care), as that is the person who's liability and insurance policy is implicated -- to have a tech do so is just bad and unworkable from an administrative policy point of view. Even the legislation described by a prior poster (which I think is not a bad idea) wouldn't want techs or support staff to make that call. The tech's role is to report any errors to the primary physician, and he can do whatever is prudent to manage any liability risk (actions which may including apologizing, or not) given the circumstances.
     
  26. Iwy Em Hotep

    Iwy Em Hotep The Welcomer
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    From my limited experience in the hospital (as an MS2), doctors apologize for little mistakes all the time. Say the doctor forgot to sign off on a prescription, and realizes it just before the patient leaves the door. Honest mistake, no problem. Everyone makes those, and no patient is going to sue for that.

    So I think the OP's doctor was being way too overzealous. Doctors, lest it be forgotten in the Pre-Allo world, are people too.
     
  27. njbmd

    njbmd Guest
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    Hi there,
    I was operating on a patient who had a persistant abdominal abscess that the interventional radiologists at an outside hospital had been unable to drain. The patient had undergone a sigmoid resection for diverticulitis after being treated with antibiotics and cooled down according to accepted medical standards. The abscess had been causing pain and chronic debilitation so the patient was sent to my hospital (we are a tertiary referral center) for further care and because our intervential radiologists are world renowned. This patient's attending surgeon felt that the patient had the best chance at a more experienced center with a nationally-known colo-rectal surgeon and good IR specialists.

    The patient never made it to the care of the colo-rectal surgeon or the interventional radiologists. The patient started to crash in the middle of the night and thus I was called into service to do the case with the attending surgeon on call. It turned out that the surgeon who referrerd the patient was a close friend of the on-call surgeon who was operating with me.

    When we opened the abdomen, the smell almost knocked us off our feet. As moved my hand down to where the absecss was located, I pulled out a green OR towel. The absess turned out to be a green towel that had been left in the patient from the previous surgery. My attending called the surgeon who had referred and told his to pay the patient and patient's family whatever they asked for because now, this patient would be sporting a colostomy for a very preventable mistake.

    As a surgeon, one never puts anything into the abdomen of a patient that is not counted and one never closes the abdomen without the count being correct and verified. To do anything less is a huge mistake. We told the patient of the mistake and of the problem. How could we have kept this hidden? The patient and their family settled for an undisclosed sum which kept me out of court and away from the malpractice lawyers.

    As surgeons, we do not "fake" perfection but we minimize mistakes. Something catastrophic can always happen. Patients do not come with roadmaps and anatomy is anything but constant. If you stay within the realm of accepted medical care and you carefully inform your patients up front what the outcomes of the procedures are likely to be, then you have few surprises. The other thing you do not do, is pack the abdomen with OR towels. Lap sponges are great for packing and are radioopaque. If the count turns out incorrect, you can get a radiograph on the table and find your sponge. If you are determined to put a green towel (used for draping) into a body cavity, you staple it to a lap sponge and you alert the scrub nurse so that they can keep count.

    njbmd :)
     
  28. pseudoknot

    Physician PhD Faculty Lifetime Donor Classifieds Approved 10+ Year Member

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    So, you would advocate a world in which employees aren't even allowed to apologize for their own, minor, mistakes? Where's the line? What if a CNA accidentally spilled a cup of water on a patient -- should they just walk away without saying anything?

    I'd like to say more, but this thread has made me too angry. I will say that I think the beliefs espoused by Shredder and Law2Doc above are repugnant and represent one of the worst things about our society.
     
  29. Law2Doc

    Law2Doc 5K+ Member
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    No, but if I'm the doctor, and its my house and insurance on the line, I think I should be in on the decision as to whether what was done was something we should apologize for, and how best to do it to not get sued. Obviously your water spilling example isn't the same, as that isn't a health issue. If more significant mistakes are made, either it's quietly fixable or someone needs to apologize. But the person who gets to make that call is the one who bears the legal and financial burdens, not the tech. If you get sued because some tech (accurately or not) decided to accept liability and as the deeper pocket of the two, in a suit with damages which exceed insurance coverage (it happens) you lose your house, savings,etc. I think you will be annoyed that you were not in on that decision.
     
  30. 63768

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    first of all njbmd, that story is awesome. i can't believe the pt's surgeon would use a green towel to stop blood or whatever. all the green towels i've seen have been used to cover sterile instruments and immediately tossed into the green linen basket. i'm surprised the scrub tech would give or allow him to use a green towel when laps are available.

    to answer the OP's question and address concerns of those like jrdnbenjamin, i think the line is drawn between hurting the patient and not hurting the patient. admission of ordering the wrong test that doesn't hurt the patient as in the OP's case has zero effect on the patient's care. why admit that? in cases like njbmd, a family member has died. that's a mistake on the surgeon's part and he must take responsibility.

    i believe professionalism involves integrity and honesty. yet, admitting you order the wrong test can be seen as "this guy doesn't know what he's doing" and brings doubts to the patient's mind. on the other hand, injecting the wrong medication/leaving surgical equipment in the patient must be admitted because as professionals, we must be accountable for our mistakes.

    if it doesn't hurt anyone, why degrade our authority in our patients' eyes when not admitting the minor mistake results in nothing?
     
  31. LizzyM

    LizzyM the evil queen of numbers
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    1. In order to sue, a patient has to suffer harm. "No harm, no foul." If an error didn't affect the patient, then there is no risk of a lawsuit.

    2. There is a long tradition of writing about mistakes and how one lives with one's self and treats others with honesty. David Hilfiker is one such author (see http://endeavor.med.nyu.edu/lit-med/lit-med-db/webdocs/webauthors/hilfiker299-au-.html for links). He is required reading at some med schools.

    Forgive and Remember, a sociological study of surgical training (residency) is a classic in terms of how attendings (and "the system") treat mistakes made by underlings but the issue of disclosure to patients isn't a major focus. Still, a very good read, even decades after publication.
     
  32. Bfriccia1

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    Just because the doctor doesn't get sued doesn't mean that there can't be reprecussions for honesty. Someone in my family was injured at an academic medical center and it resulted in permanent damage. The doctor who was treating him admitted that they all made a mistake and the hospital that he had trained at and worked at for years promptly fired him for doing the right thing. It is sad that we can't admit mistakes because that really is the right thing to do (if it was you who was injured you would want to know why). The hospitals and doctors are so afraid of lawsuits however that many mistakes don't ever get admitted to (and doctors make a LOT of mistakes...a Harvard study estimated that over 100,000 deaths per year and due to physician negligence...that is a scary number).
     
  33. masterMood

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    because nowadays doctors can be sued for the littlest of things. People realize that doctors make a lot of money, and that there is no harm in suing the doctor. Unlike other countries, only America has the system where if you sue someone, the defendant must hire an expensive lawyer, pay extraordinary fees, and if the defendant is proven innocent LOSES all that money. I'm not sure exactly how it works in Europe, but I think in the U.K. when the plaintant sues the defendant and the defendant wins, the plaintaint has to pay for his fees.

    Quite frankly, the system has to be fixed first before doctors can be expected to be fully honest.

    In fact, yesterday in my dorm hall, some kids were playing with air pistols (they're harmless but they hurt a lot), one kid got shot in the arm, got pissed off and started chasing the other kid in the hall. The kid who was running away was aiming at the kid who was chasing him, and the kid who was chaswing him ended up hitting his head against the door frame when he tried to jump out of the way. Kid had to go to the hostpial to get stiches on his forehead because he was bleeding profusely and you could see bone. The kid with the gun ended up telling university police that they were playing with air guns and ended up with the other kid hitting his head on the door frame. Now he was being honest, but also being stupid at the same time. Because he could of just told the university police that they were running in the hall and this accident happened. But since he told the officer, his air pistols were taken away, and now he's being written up for a misdemeanor.

    It's definitely the same policy of "don't ask, don't tell"
     
  34. silas2642

    silas2642 silas2642
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    Okay, so we can argue this all day by pointing out what may or may not happen if we admit we did something wrong. But does anyone think that we should admit our mistakes because it is simply the right and ethical thing to do, and not worry so much about covering our own asses?
     
  35. Law2Doc

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    I agree with you that there is no risk of damages for a harmless error -- I doubt that is the kind of error we are concerned about. But I do note that by admitting to harmless error, if a harmful error does later occur in the care of the same person, you may have created a pattern of negligence based on which a jury could come to a conclusion that the standards of care were not being met, and that crummy treatment was being given from the onset. Again, I'm not saying that admission of mistakes is not necessarilly the smartest policy. Some studies suggest it is. Many people who feel you are honest with them and adequately communicate the risks will not sue. But some do - and thus the person ultimately liable (i.e. the doctor and hospital) needs to consider and measure the team's response, as an apology is often an admission of wrongdoing and carries weight in court. I strongly think, however, that the techs and support staff should not be the ones binding the doctor to positions of liability without consulting them.
     
  36. Lorrayne

    Lorrayne Senior Member
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    I don't agree with those who say it may be better to lie for liability reasons. I think patients and their families are going to be much more understanding of mistakes if physicians explain what happened and why. My stepfather is an pediatric anesthesiologist, and he believes he has avoided lawsuits on several occasions by being completely honest with the family when mistakes happen. Though the family members are not witnessing what goes on in the OR, he feels it is important to keep them informed about exactly what takes place: good or bad. He has been practicing for almost 20 years and has never been sued.
     
  37. silas2642

    silas2642 silas2642
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    Yes, but whatever happened to being responsible for your own actions. I agree that lawsuits have gotten way out of control, but when someone has done something wrong, there are consequences, and as a responsible human being, shouldn't one be accountable for his/her actions?
     
  38. Law2Doc

    Law2Doc 5K+ Member
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    From a moral sense, sure. But unfortunately, in our litigious world, that Pollyana attitude will sometimes end you up de-licensed, uninsured, broke and/or homeless. You need to lead your life and run your practice according to the societal rules and norms, and sometimes that means papering your actions, having patients sign waivers, and strategically deciding if, how and when to admit wrongdoing to minimize consequences. Every doctor gets sued at least once during their career these days, sometimes for bona fide mistakes, but often for something not their fault, because they have assets and may have been in the room.
     
  39. Law2Doc

    Law2Doc 5K+ Member
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    I think if patients only sued doctors when they were at fault, instead of just being in the room when something bad goes down, then doctors might be more agreeable admitting when they actually screwed up. Most doctors get sued, but most suits do not result in a finding of wmalpractice on any or all the parties sued. Again, sometimes it is a good anti-suit tactic to apologize to the patient. But I still say it is the doctor's call, not the techs.
     
  40. CTSballer11

    CTSballer11 Senior Member
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    I am with the dont ask dont tell policy.
     
  41. silas2642

    silas2642 silas2642
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    Oh, come on. Admitting you made a mistake may get you sued, but I doubt it will get you delicensed; from what I can tell, if you've had your license taken away, then you really deserve it. There are docs who have slept with patients, absused drugs and alcohol on the job, screwed over medicaid, and so on and so on and so on, all they've received is maybe a probationary period or a period where their license was suspended. Most of these physicians are still practicing, however.

    Put it this way: is it possible that medicine is not about US as healthcare providers, but the patient? Perhaps when making decisions we should obey the golden rule and think about what is best for the patient, what we would want if we were in their position, instead of what is the best way to make a buck/keep a buck.
     
  42. Law2Doc

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    You can try to do what's best for the patient without putting your livelihood in jeopardy. Again, I'm not opposed to admitting mistakes, and sometimes it is the smart approach, but am cautioning that it should be done by the person who bears the liability, and after careful consideration of his words and the possible repurcussions. If you work in a field where you bear the likelihood of being sued, (as some of us career changers have) you take certain precautions. That's life. I don't always like it either, but common sense dictates practicing a certain level of defense.
     
  43. humuhumu

    humuhumu nukunuku apua'a
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  44. runnergirl

    runnergirl Junior Member
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    I had a similar interview experience -- the interviewing doc asked what I would do if I forgot to inform a patient of positive test results (in fact, never checked up on the results in the first place), and then two years later realized the mistake when the patient came in with full-blown prostate cancer. I finally answered that as hard as it would be, I would admit my mistake to the patient and deal with the consequences. The doc then said that one of the biggest problems with physicians today is that they refuse to admit their mistakes, and try to pretend they are perfect. I definitely agree with everyone who has said that they think honesty is the best policy -- I know that if I were a patient I would hope that my doctor would tell me if he made a mistake. I think most people definitely appreciate knowing that doctors can mess up sometimes too -- it puts them more on the level of an equal and makes the patients feel more comfortable. Just my two cents.
     
  45. 63768

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    that is what you'd hope people would think. more often than not, it brings up the idea that we may not be as competent as we're supposed to be, which we aren't. yet, that competence, though faked, is essential in our role as caretakers.

    in my opinion, little things that have no effect are fine left untold.
     

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