I'm a big believer in the notion that good medicine is as much an art as a science. This view is partly based on the belief that the effectiveness of a healthcare professional is influenced not only by things like knowledge and technical know-how, but also by their ability to communicate with patients clearly and with compassion.
One situation where communication between doctor and a patient can be of particular importance is when things go wrong. Doctors can make mistakes (we're only human, after all), and when we do, the results can be catastrophic.
In a recent edition of the New England Journal of Medicine (NEJM), two doctors relate what they learned while making a film about the effect medical errors have on patients, their families, and the doctors concerned [1].
It is widely accepted that doctors may feel a sense of guilt or shame as a result of their mistakes. However, the piece in the NEJM also put forward the idea that family members often have similar or even stronger feelings of guilt, primarily because they feel they were not around to protect their loved ones.
Another theme uncovered in the making of this film was the fear patients and their families may feel about further harm that may be endured, including retribution from health-care workers, if they were to express their feelings or even ask about mistakes they perceived. The researchers further identified a potential for doctors to turn away from patients who have been harmed, isolating them just when they are most in need.
Overall, the NEJM calls for clarity when things go wrong and for a culture in which it's easier for doctors to say, "Sorry."
So why is it so difficult for doctors to admit that they have made mistakes? One of the possible explanations, of course, is that a doctor genuinely interested in helping individuals will almost certainly find the thought of harming a patient an uncomfortable one. One strategy that might be used here is to attempt to ignore the issue, or at least suppress it from his or her mind.
Also, medicine is a profession where the stakes are high, not just in terms of patient outcomes but also professional reputation, and perhaps even eligibility to practice at all. In such an environment, doctors can sometimes find that facing up to things and saying sorry is beyond them.
As the article points out, one factor that is almost certainly feeding into this is the potential for litigation. According to the authors of the NEJM piece: "Although full disclosure of medical errors is increasingly recognized as an ethical imperative, health care providers often shy away from taking personal responsibility for an error and believe they must 'choose words carefully' or present a positive 'spin.' Hospitals, insurers, and attorneys frequently advise physicians against using trigger words, such as 'error,' 'harm,' 'negligence,' 'fault,' or 'mistake.'"
The authors suggest that what we need is a structure that restores communication and supports emotional needs. In particular, they make a call for patients and their families to have input in any changes that are deemed appropriate. Getting the issues surrounding medical errors into the open is a good thing, and involving all relevant parties in the seeking of a solution makes eminent sense to me.
One of the reasons I am writing this is because, as a doctor, I have encountered many occasions when patients feel they have been "wronged," but also feel angry or bitter because they feel they never got to the truth or never had the apology they felt was due to them.
For some patients, the word "sorry" has enormous power. And I suspect saying it more often may do a lot of us doctors a power of good too. My hope is that in the future we develop a culture in medicine where this word is uttered much more readily.
References:
1. Delbanco T, et al. Guilty, Afraid, and Alone—Struggling With Medical
Error. NEJM 2007 357(17): 1682–1683
Dr. John Briffa is a London-based doctor and author with an interest in nutrition and natural medicine.
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