An interesting question.
Amy Tuteur asks this question at a dinner party, and it elicits a whole host of responses. If a patient asks directly, the answer is easy. But what if the patient doesn’t ask? Is there an ethical requirement to disclose another physician’s error?
My first reaction, along with Dr. Tuteur’s, would be full disclosure, meaning that the patient should know everything that any doctor would want to know in a similar situation.
However she finds some resistance to that position, with other medical professionals arguing that “telling a patient about a mistake that cannot be fixed will upset her unnecessarily, erode trust in a doctor the patient may be still relying upon, and provide absolutely no benefit.”
Perhaps elucidating whether a patient would want to know such information should be elicited first before proceeding.
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If you are not willing to also testify in front of a court as an expert witness against that physician, don’t do it.
The following articles reiterate that disclosure is the best policy, and that disclosure has no effect on litigation.
Five Years After To Err Is Human: What Have We Learned? by Leape and Berwick, JAMA Vol 293 No 19 May 18, 2005
What are the repercussions of disclosing a medical error? by Calvert and Hollander-Rodriguez, Vol 57 No 2 Feb 2008 Journal of Family Practice
And if I find out later that “you” knew and didn’t tell me, I have a case against YOU, right?
Dr. Kevin .. thx for your hard work .. my $0.02, after years in network operations center ..
With all the parasite lawyers, circling about .. you have to log the error, to protect yourself legally. In writing. Copies in your file and other appropriate parties.
“Wall Street Journal” editorial page first issued warning about sub-prime lending NINE YEARS AGO.
“Barron’s” publicly questioned Bernie Madoff’s methods — EIGHT YEARS AGO.
Not issue of “I told you so.” More like, “lousy parasite lawyers, get off me.”
It’s definitely an interesting question, but to me, representing a patient’s point of view, the answers aren’t being looked at in quite the right way.
Suppose your car had been making a major racket, and your second-opinion mechanic figured out the problem was caused by something that could have been fixed a year before by your first mechanic. Now the engine is practically ruined, and it has cost you megabucks, not to mention time and anguish, because the first mechanic didn’t do his job correctly. Your car will never run correctly again.
Would you want to know about that? Of course you would. And you would expect that original mechanic to own up to the problem he caused, too.
Why? Two reasons. You want to know that the original mechanic (doctor) will pitch in to help your car (you) get as well as you can (although, yes, I realize that the possibility isn’t great). Further, you want to know that doctor won’t miss the original diagnosis for the next person. It may be small consolation, but it’s some.
I actually find this question, and the statement by some of the MDs who responded on Dr. Tutuer’s blog saying they wouldn’t want to know about the missed diagnosis, to be disingenuous. It highlights what I’ve contended for a long time, that once a doctor has that medical training, and develops a camaraderie with other doctors, he or she can no longer think the way a patient with no medical training thinks. That doctor can no longer clearly see a patient’s point of view.
Trisha Torrey
Every Patient’s Advocate
http://EveryPatientsAdvocate.com
http://patients.about.com
Disclosure is the only ethical option.
Pretty arrogant, Kevin. You think you can really have the correct answer for another time and patient presentation. Clinical care is a series of single case on-off experiments. That a prior remedy failed means, you do not have to do it, and can move to another, making yourself look good, if it works.
Most medmal cases are weak, so say judges, juries and appellate courts, and at every stage of litigation. The expert witness has the litigation privilege that immunizes irresponsible declarations of superior knowledge. These irresponsible second guessers then get to boss the doctors of an entire state at the point of a gun of the government. These inexperienced academics get to impose their atavistic garbage science on far more experienced and intelligent clinicians.
This litigation privilege is to generate lawyer jobs. I do not differentiate between the evil that the defense bar does compared to the plaintiff bar. They work together to attack clinical care.
As a patient, I suggest that plaintiff experts and other arrogant second guessers get placed on a list. They get shunned by all service and product providers. If their boiler breaks in 0 degree weather, no heating technician may answer their call. If they enter a supermarket, security expels them without their groceries.
When doctors don’t admit to mistakes, they project a false image of perfection which may be believable in the short term but will not hold up for long. When a mistake is made, the patient is violated in some sense. Perhaps not in a huge way (a dental mistake caused me to lose a tooth), but the patient has a right to know what has been done to his or her body.
I think if doctors were generally more open about the mistakes, patients would have more realistic expectations and accept that mistakes are a part of life.
Not sure what it would take to turn all this around, though!
My experience has been that while they SHOULD report mistakes, the culture mandates that physicians close ranks and cover for each other: http://adventuresincardiology.com
or Google “Adventures in Cardiology”
Not informing the patient denies the patient the ability to choose another doctor if s/he determines that the error is significant enough to end the doctor/patient relationship.
Respectfully, some of you are forgetting that doctors are only half of the equation.
Reading the thread it was unclear as to whhat was commented on in the inital chest X-ray. Of course total disclosure and honesty by the doctor should occur. However, it is easy in hindsight to look at f/u chest X-rays/CT scans and then the initial thereby stating “that is where the cancer started”. It is a little tougher real time. If the reading on the chest X-ray did not suggest f/u CT or even consideration of malignancy then I would have a hard time blaming the PCP. People outside of medicine tend to view these diagnosis as black and white (such as say a rare lymphoma). In reality it doesn’t work that way. Early cancer diagnosis is often not easy. Clinical docs are often only as good as their pathologists and radiologists.
Trisha:
re: “It highlights what I’ve contended for a long time, that once a doctor has that medical training, and develops a camaraderie with other doctors, he or she can no longer think the way a patient with no medical training thinks. That doctor can no longer clearly see a patient’s point of view.”
I am not only a doctor. I am a patient, father, son, and husband. I assure you I can see a patient’s point of view. Your personal opinions of doctor’s is well known. The sad fact is you have turned your own personal expereince with one diagnosis/oncologist into a blanket statement against all doctors. It is really and truly sad.
In the case that is the subject of Dr. Tuteur’s post, an oncologist who is treating a pt for lung ca finds in the pt’s records “the lung cancer had been seen on a chest X-ray more than a year before the diagnosis, when it was still quite small and easily treatable.”
If I was the oncologist, I would tell the patient the facts- that the tumor was present on a prior x-ray but would be careful not to lay blame.
We don’t know who is at fault here. Did the PCP get back the x-ray report? Was there a f/u appt after the x-ray that the patient missed?
The oncologist has an ethical duty to inform the patient of the error. But since he doesn’t know for sure that it was 100% the pcp’s fault, he should be careful not to lay blame- the patient can figure this part out for himself.
Agree w Supremacy. You are in no position to know whether the previous doctor made an error of judgment, an error of action, or any kind of error at all. Monday-morning quarterbacking serves nobody well (except perhaps trial lawyers, who, as I understand it, are the only people on the planet who can interpret a fetal heart monitor).
The best course of action would be to communicate with the previous doctor whose judgment and knowledge are in question. Ask him or her what he thought of the case. If you don’t do this, you know nothing. Your input is therefore likely to be destructive.
What wasn’t mentioned was who read the prior x-ray, and why it was taken. Did (he PCP read it? Did a radiologist? Was it somebody else? Did the pt come in with some condition requiring a cxr that could have caused the original doctor not to find the ca? It’s a tough call if the doctor who read the x-ray was not able to interpret it the same way the oncologist did later. IANAD, but I don’t see any reason to bring up a potential mistake made by another doctor, unless there is an element of profound negligence or obvious malpractice.
Anonymous,
It’s peculiar that you know so much about my work, but you believe somehow that it clouds my opinion of doctors. Nothing could be further from the truth. In fact, if you ever read the bulk of what I write you would see that I most often defend doctors based on the constraints under which they (you)operate. I do so to help patients understand why their health care just isn’t the Welby-ism it used to be. I will allow that when it comes to talking about medical mistakes, I do have a very unique perspective, and it’s very difficult for me to be objective.
I don’t ever claim to embrace a doctor’s point of view, only a patient’s. I do try to help patients understand a doctor’s point of view, however, because I believe that helps all of us communicate better.
Look at it this way: can you ever subtract your ability to read? Of course not. Can you read and understand something written in the Russian language? Probably not. You, as a trained physician, can “read” both patient language and physician language — and you can never subtract that. Patients, on the other hand, can “read” only patient language. They cannot read medicine because they haven’t been to medical school. It puts us in a very vulnerable position which doctors (you) can’t understand. It’s all Russian to us, (or perhaps Greek.)
I stand by my statements. And I sign my name to them, Anonymous.
Trisha Torrey
Every Patient’s Advocate
http://EveryPatientsAdvocate.com
http://patients.about.com
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