Medical culture encourages doctors to avoid admitting mistakes

If you become the victim of a medical error, should you trust your doctor to be forthright about his or her role in the mistake? That could be a bad idea. An alarming new study says that most doctors would try to obscure their role in the mistake, and most wouldn’t even apologize.

The study, conducted by a national team of researchers, posed two hypothetical scenarios involving medical error to more than 300 primary care physicians and asked how they would react. The first scenario involved a delayed diagnosis of breast cancer; the second involved a delayed response to a patient’s symptoms due to a breakdown in the coordination of the patient’s care. Most (more than 70 percent) of the physicians surveyed said they would provide “only a limited or no apology, limited or no explanation, and limited or no information about the cause.” The report was published last fall in the journal BMJ Quality and Safety.

The researchers noted that the strongest predictors of disclosure were “perceived personal responsibility, perceived seriousness of the event and perceived value of patient-centered communication.” In other words, doctors decide whether a mistake is a big enough deal to reveal to their injured patients.

In reality, the factor that most influences doctors to hide or disclose medical errors should be clear to anyone who has spent much time in the profession: The culture of medicine frowns on admitting mistakes, usually on the pretense of fear of malpractice lawsuits.

But what’s really at risk are doctors’ egos and the preservation of a system that lets physicians avoid accountability by ignoring problems or shifting blame to “the system” or any culprit other than themselves.

The lengths to which some doctors will go to shirk their responsibility to be upfront about medical errors are astounding. I consulted with one patient who experienced this kind of blame-shifting firsthand.

After what was supposed to be a routine spinal fusion procedure, Natalie (not her real name) awoke in extreme pain. The neurosurgeon put her on steroids for pain relief. Two days later, a different neurosurgeon discovered in post-operative imaging that the surgeon who performed the procedure had put a screw inside Natalie’s spinal canal — far from where it should have been and a tiny distance from damaging her spinal cord.

The original surgeon’s explanation? “The screw migrated.” Buffalo and geese migrate. Medical screws placed properly and carefully into bone do not.

As patients, we are conditioned to assume that our doctors know best and always have our best interests in mind. When they refuse to own their mistakes, they betray that trust and foster an environment in which patient safety takes a backseat to doctors’ reputations.

The end result is a medical culture in which errors cause 250,000 deaths per year in the United States alone, making it the third leading cause of death, behind heart disease and cancer, according to research published last year by Dr. Marty Makary, a Johns Hopkins surgeon and outspoken patient safety advocate, and research fellow Michael Daniel.

What is a patient to do in this environment? The first thing is to be aware of your own predisposition to take everything your doctor says at face value. Listen closely and you may hear cause for more intense questioning.

You will likely never hear the terms negligence, error, mistake, or injury in a hospital. Instead, these harsh but truthful words and phrases are replaced with softer ones like accident, adverse event, or unfortunate outcome. If you hear any of these euphemisms, ask more questions or seek another opinion from a different doctor, preferably at a different facility.

Most doctors would never tell a flagrant lie. But in my experience as a neurosurgeon and as an attorney, too many of them resort to half-truths and glaring omissions when it comes to errors. Beware of passive language like “the patient experienced bleeding” rather than “I made a bad cut”; attributing an error to random chance or a nameless, faceless system; or trivialization of the consequences of the error by claiming something was “a blessing in disguise.”

When a serious preventable medical error occurs, the physician who made it always has the option to do the right thing and fully disclose what happened. He or she can make an honest apology, which must include accepting responsibility for the error. He or she can also explain what options are available for compensation. Anything less is a pseudo-apology at best and a cover-up at worst.

Lawrence Schlachter, MD, is a board-certified physician, a medical malpractice attorney, and the author of “Malpractice: A Neurosurgeon Reveals How Our Health-Care System Puts Patients at Risk” (Skyhorse Publishing, January 2017).