What to do after you make a medical error

Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.

Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year.  It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, vomiting and dizziness prompting an urgent 911 call.

Where she thought her symptoms were attributable to bad heartburn, the studies at her local hospital demonstrated otherwise: She was found to have severe disease in all of the major oxygen-carrying vessels that supplies her heart and was at a high risk for a fatal heart attack without surgical intervention.

While caring for Ms. A overnight, I made the incorrect decision to administer a cardiac medication to treat her disease that is known to increase the risk of bleeding during surgery.  Given her need for the operation, the benefit of providing this medication to safely temporize her heart condition in the short-term did not outweigh the risk of delaying the intervention that she ultimately needed.  Despite the standard of care regarding this clinical scenario, I made the wrong call.

The background

Making a medical error is the most feared consequence of practicing medicine.  From misreading lab values to doing surgery on the wrong site, any slip in clinical judgment can potentially cause serious injury or even death.  A landmark study conducted by the Institute of Medicine (IOM) demonstrated that medical errors in the U.S resulted in around 75,000 unnecessary deaths and over 1 million excess injuries each year. Despite this data, it is remarkable that medical errors are made every day and usually result in little to no negative patient outcomes.

Whether one is just starting out as a physician in medical training or is a leader in their respective field, all medical providers will make mistakes during their careers.  Given the fact that this is an unavoidable facet to making thousands of clinical decisions each year, how does one appropriately deal with such errors?

Unfortunately, many practitioners choose not to deal with medical mistakes at all.  In a study surveying the prevalence of non-disclosed medical errors, over 30% of physicians and nurses underreported almost half of medical decisions that they perceived as clinical oversights. Not only is this blaringly unethical but also limits the medical community from creating stopgaps to avoid such errors in the future.

The solution

There are several steps to appropriately dealing with a medical error that are relatively straightforward:

1. Let the patient and family know. Many healthcare providers fear that notifying patients of an error will decrease rapport and put them at a higher risk for receiving malpractice lawsuits.  Interestingly, a report from the University Of Michigan demonstrate otherwise: the more that patients and their families are notified of serious mistakes, the less they are inclined to reactively sue.

Regardless of the tangible consequence of making a medical error, practitioners have the ethical duty to let their patients know of any significant clinical oversights.

2. Notify the rest of the care team. Alerting the rest of a patient’s care team of a medical error is not easy: it essentially demonstrates one’s fallibility to his or her colleagues and may result in considerable changes to the predetermined patient care plan.  Despite this, these errors must be relayed to the rest of the care team in order to better handle any immediate significant negative patient outcomes and reduce further mismanagement from occurring.

3. Document the error and report it to the hospital safety committeeIn order to avoid further complications to a patient’s care, it is essential that the medical error be appropriately documented and reported.  By doing so, it avoids further complications by independent healthcare providers who also assume care of the patient and can globally increase patient well-being by improving hospital-wide safety measures.

The take home point

Committing and dealing with a medical error is one of the more humbling experiences in the field of medicine.  I know this now from personal experience.

Given the fact that making clinical errors in judgment is an inevitable aspect to clinical practice, it is imperative that practitioners of all levels of training be aware and comfortable in appropriately handling such events.

The patient’s demographic information in this article was changed to protect identity and assure anonymity.

Brian J. Secemsky is an internal medicine resident who blogs at the Huffington Post.  He can be reached on Twitter @BrianSecemskyMD.

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  • Suzi Q 38

    It was refreshing to read your story.

    I thought that most physicians would almost always not mention it, allow the patient to go through with the procedure, and if the patient’s health declined or h/she died, no one would know the wiser.
    Thank you for your honesty.

    I would have been grateful for your admission and appreciated your honesty. I would have kept you as my physician, because I would know now that I could trust you. I would know that you were always straight with me, and I would realize that you have a difficult job and mistakes can be made.

    I would not have sued you, because it would have been way too expensive to do so, and in the end, I did not die.
    In other words, there were no lifelong damages.

    I would have appreciated the fact that medical staff could be alerted and I would get the proper care with the error in mind.

    The benefit to you would be that you could hopefully sleep better at night, knowing that you made sure that I was O.K.

    • rbthe4th2

      Same here. I would have thought higher than 30% because those are the number of errors I see. I have 2 sets of docs I can trust – and those are because of the above. I lost one doc I used to have for moving, but he was the same way.
      I’m not into a lawsuit. Lawyers complicate everything. How about we fix my health together? I’m going to make mistakes and forget to tell you things, you’ll do the same. Lets just try to get through this without making big boo boos?

  • petromccrum

    Thank you, thank you for doing the right thing. Even though many mistakes do not result in death they can and do create additional medical problems for patients. It would go a long way for patients peace of mind and recovery if all doctors would admit to mistakes, take corrective action, and apologize. I believe there would be a lot FEWER lawsuits.

  • KJK

    Thank you for this article.
    It was very amazing to read your story.
    As a pharmacist medication errors and errors of any type are such a scary thought. Terrifying in fact. It was nice to read this it gave me some perspective. thank you!

  • JockatCRICO

    Now that disclosure and apology is becoming either mandated (in Massachusetts, for example) or simply recognized as the right thing to do, the next important step is give physicians the training and support needed to do the thing right. A structured and coordinated disclosure and apology is helpful to all parties, a shoot-from-the-hip approach risks making a bad situation worse. Physicians who have training and (simulated) practice in giving bad news-and who coordinate their actions with their colleagues and safety leadership will fare better than those who go it alone and wing it.

    https://www.rmf.harvard.edu/Clinician-Resources/Audio/2012/New-Apology-Disclosure-Rules-Take-Effect-in-MA

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