When Physicians Fail: Moving Past a Medical Mistake
June 25, 2018
By Debra Wood, contributor
Health care professionals never
set out to make a medical mistake, but errors, missed diagnoses and other
missteps that harm patients can happen--often due to system failure. Physicians
and other health care providers often become the second victims of an error or
human, and we will make mistakes,” said Eunice J. Minford, MBChB, MA, FRCS Ed,
a consultant surgeon in Northern Ireland. “It is a fact. Every single doctor
makes mistakes without exception. The key is, how do we deal with them and
understand them in a way that is healthy?”
Manisha Juthani-Mehta, MD, at
the Yale School of Medicine in New Haven, Connecticut, added, “It is important
to always recognize that our patients have welcomed us into their lives at a
vulnerable moment. We should treat people with honor and respect in these
moments. Despite practicing with this principle in mind, we are all human and
can make mistakes.”
Physicians and other health care
providers aim for perfection and can be devastated when that’s not the outcome.
In a Boston Globe op-ed piece from August 2015, Juthani-Mehta described how she had
not forgiven herself for an error made during her internship, even 14 years
later. She reported for this article feeling the same.
Positive steps to deal with medical errors
Acknowledge, disclose and communicate
Errors often occur as a
result of system problems, said Doug Wojcieszak, founder of Sorry Works!, a
nonprofit disclosure training and advocacy organization in Edwardsville, Illinois.
Multiple factors may
contribute, Minford added.
Correcting system problems
requires disclosure of the medical error or misdiagnosis.
Many organizations have
embraced disclosure when an error occurs, said Wojcieszak, who recommends a
three-step approach. Begin by empathizing with the patient or family, quickly
conduct a review of what happened and report the results of the review to the
patient or family, apologize and explain what will change, so it does not
“Stay engaged with the
patient and family,” Wojcieszak advised.
Juthani-Mehta said that if
a medical mistake happens, “acknowledging and accepting the error is the first
important step. Discussing it directly with a patient can also be very
therapeutic for both the physician and patient.”
Acknowledging the error
allows for an analysis of what happened and why.
“An acknowledgment that an
error has occurred is fundamentally critical as it allows for the process of
investigating root causes of the error or mistake,” said Shawn C. Jones,
an otolaryngologist in Paducah, Kentucky. “The
purpose of these activities ideally should focus on improving processes in
order to prevent similar occurrences while simultaneously avoiding assignment
of blame as a punitive endeavor.”
Wojcieszak suggested physicians
interviewing for a position ask the
employer how medical errors are handled.
“Too many hospitals and
nursing homes do not have plans,” Wojcieszak said. “Some organizations have it
down cold, with a team of people, and it’s been trained.”
Be aware of legal considerations
Physicians and other health
care providers are concerned with legal liabilities associated with adverse
events or errors.
“It would be unwise not to
take the legal ramifications into consideration,” said Jones.
“With the exception of New Jersey, all states and the
District of Columbia have enacted statutes affording some degree of protection
of the disclosure of peer review information.”
Jones added that “awareness
of the limitations of your capacity as a human being is crucial to maintaining
a sense of well-being. Living in a community of peer support and having a sense
of nonjudgmental awareness helps to be able to look honestly and transparently
at mistakes while simultaneously being able to look with hope and purpose to
the future in spite of those mistakes.”
Reflect, take responsibility and move on
When physicians fail, they often become the second victim. In 2018, Spanish
researchers reported that failure has adversely affected 7 out of 10 health
workers. Seeking clinician
support services from their organization or
outside resources can be beneficial.
can be paralyzing; they can disempower us and cause us to lose confidence, and
we can be seriously affected by them,” Minford said. “All of that can then
detrimentally affect the quality of care we give. But we did not come into
medicine to hurt or harm people, nor did we come in to medicine to end up worse
off than the patients we are caring for.”
must learn to handle mistakes in a way that is not detrimental to their own
health, Minford continued.
suggested the physician take some time away from the care environment after a
mistake. Cancel appointments or surgeries for a week.
have been involved in an [adverse] event, you are more likely to have another
event shortly thereafter,” Wojcieszak said, adding that, as a second victim, a
physician needs time to grieve.
always live with you, Juthani-Mehta said, but communicating directly with the
patient can help facilitate the healing process for both parties.
need to learn to forgive themselves, but this can only happen when you accept
that you are fallible first and have the humility to do so,” Juthani-Mehta
Second Victims: Support for
Clinicians Involved in Errors and Adverse Events - AHRQ
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