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It's So Hard To Say I'm Sorry
The financial and personal ramifications that come when a doctor
apologizes to a patient.
By Rahul Parikh
Posted Friday, Nov. 6, 2009, at 7:15 AM ET
When you're a doctor, you sometimes have to
come to terms with making a mistake: giving a
patient the wrong diagnosis or the wrong
treatment, causing an injury, or perhaps
something worse.
In one case I still think about, Andy (I've changed
his name to protect his privacy) was a healthy
teenager with migraines. "Take 600 milligrams of
ibuprofen to start, and if that doesn't work, I'll
prescribe something else," I told him. But in the
month that followed, Andy's headaches grew
worse.
I found nothing abnormal when I examined him.
When I reviewed his records, I noted that he was
taking anxiety medication prescribed by a
D o c to rs somet imes have to say so rry
psychiatrist. Perhaps that could be causing his
symptoms, I thought, so I referred him back to
psychiatry and to a neurologist before sending him home.
The next morning, I received a message from the emergency
room. After his appointment, Andy had had a seizure in a store.
In the emergency room, a doctor noticed something important
when he looked at Andy's eyes with an ophthalmoscope: swelling
of the optic disc, located in the back of the eye. Papilledema, as it
is called, is a cardinal sign of increased pressure inside of the
head. Had I seen it, I would have done exactly what the E.R.
doctor did—ordered a stat CT scan, which revealed that Andy had
deposits of fluid in his brain. Had it worsened, the pressure could
have caused Andy's brain to herniate down into his spinal cord,
which may have killed him. When I had examined Andy's eyes the
same way, I missed the papilledema.
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There are at least 25 definitions of the word error in medical literature. But the regret, fear,
shame, and self-loathing I felt were all the definition I needed. How could I have done this?
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It's So Hard To Say I'm Sorry
The financial and personal ramifications that come
when a doctor apologizes to a patient.
http://www.slate.com/id/2234322/[11/9/2009 10:59:37 AM]
The financial and personal ramifications of a doctor apologizing to a patient. - By Rahul Parikh - Slate Magazine
Rahul Parikh | Nov. 6, 2009
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Depending on what estimate you choose to go by, medical errors kill as many as 100,000
people each year. Doctors, nurses, and other health care providers make many more
nonlethal mistakes. Studies tell us that patients—understandably—want to know when a
mistake has been made with their health, and several professional organizations, including
the American Medical Association, say doctors should disclose screw-ups. Nevertheless,
there is a long-standing culture of concealment in medicine. While outside observers often
attribute it to our fear of being sued, there's something more: Doctors don't like to admit
they are fallible—it cracks our visage of authority.
In recent years, however, there has been a shift toward full disclosure—even toward
apologizing for our mistakes. Despite physicians' resistance, this change has helped regain
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our patients' trust and prevented malpractice suits.
We didn't start disclosing and apologizing out of the goodness of our hearts. Like most
changes in medicine, a series of events had to nudge us along. First came the Institute of
Medicine's 1999 report "To Err Is Human," which contained that oft-cited statistic of 100,000
deaths and lifted the veil from our culture of concealment (although more than a few people
dispute that number). In 2001, the Joint Commission, an organization that accredits
hospitals—the medical equivalent of the Good Housekeeping seal for consumer products—
mandated that hospitals disclose unanticipated medical outcomes. States entered the
debate, too, when they began trying to encourage transparency by passing "apology laws,"
some of which make a statement admitting fault inadmissible in court, though these laws do
not make a physician immune to a malpractice suit. Today, 35 states have laws protecting
doctors' apologies and statements of regret.
Apologies have had a positive impact on doctors, patients, and hospitals. In 2001, the
University of Michigan Health System adopted a policy for handling medical errors that
centered on the principle of disclosure and apology. After one year, the hospital saved $2.2
million in malpractice claims, and the savings have continued. (The University of Michigan's
emphasis on disclosure and apology is just one part of its policy. It also quickly
compensates patients for any harm done, which has probably saved money by cutting legal
expenses.)
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Literature suggests that a simple apology won't keep a wronged patient from turning to a
lawyer—just look at this study from September. Dr. Albert Wu of Johns Hopkins and his
colleagues showed 200 volunteers randomly selected videos simulating doctors disclosing an
error to a patient. Wu and his team varied the extent of the apology (full, nonspecific, none
at all) and acceptance of responsibility (full, none). Patients responded more favorably to
physicians who apologized and took responsibility for a mistake. But even subjects whose
scenarios came with a full apology and disclosure didn't reconsider their desire to seek legal
advice.
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The financial and personal ramifications of a doctor apologizing to a patient. - By Rahul Parikh - Slate Magazine
Why Do Doctors Wear White Coats?: Because they say "science."
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Rahul K. Parikh is a physician in the San Francisco Bay Area who writes about medicine and society.
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Outcomes from treatment from individual doctors and performed at different hospitals fit a Bell curve. Your
chances of recovery from a serious illness depends in large part on who you go to and where you go to for
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Doctors are taught the old adage, "When you hear hoofbeats, think of horses, not zebras." It's what he did
here and it was wrong. Okay, that's understandable. If he had spent all of his time wildly pitching around for
an obscure cause of the migraines, it would have been a waste of everyone's time. I think Dr. Parikh didn't
see the abnormality in the boy's eye because he wasn't looking for it; had he been searching for any and all
clues as to cause of the problem, he might have looked at everything more closely. It's the same reason
why you've never noticed a particular store that you've driven by a million times until someone points it out
to you--it just wasn't relevant information at the time. Doctors are trained to be more aware than the
average person, granted, but they are still human and just trying to get through the day like the rest of us by
filtering the information that they need at the time. I'm a librarian, and hundreds of studies have proven time
and time again that researchers absolutely do not retain information literacy skills, such as how to find
books in a catalog, until they actually have a reason to use that book in order to fulfill a "real" need. All the
instruction in the world won't matter unless you make it relate to helping that person solve a problem in their
own lives. If human brains weren't able to do this, we'd be so overloaded with information that our ability to
process info would shut down entirely!
All that being said, I think Dr. Parikh is a wonderful physician and a big man for stepping up and
apologizing. It took real guts! My experience with most doctors is totally the opposite. If they can't find an
immediate cause to your problem, it must be the patient's fault or "all in your head." They're so blinded by
arrogance, pride, or both that they just dismiss you outright. If I did that every time I had a tough question
but couldn't readily find an answer, I'd be fired so fast it would make my head spin. Somehow, though, it's
considered more acceptable in the medical profession, and that has to change, too.
-- me2too
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The financial and personal ramifications of a doctor apologizing to a patient. - By Rahul Parikh - Slate Magazine
Acai Berry Diet EXPOSED (Official Report)
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