I

f 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.

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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).

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  • A friend of mine is dead thanks to the carelessness of a medical professional. He failed to diagnose what turned out to be skin cancer
    (she had already been through breast cancer and undergone treatment successfully) and yet he still gets to practice medicine. Where’s the justice? My friend is owed that. I only hope that karma comes to this pathetic excuse for a human being who has the audacity to call himself “Doctor”. Something has to change. Someone needs to admit culpability. Otherwise, why trust anyone in the profession?

  • I had my Laparoscopic hiatal hernia repair with SurgiMend biomaterial buttress of the hiatus and Toupet fundoplication in 2016 after that surgery DR decide to evaluation to do endoscopy and Bravo PH test in august 2016 during test Bravo PH device injured pharyngeal esophageal perforation.Accident cause my test had been done outgoing Hospital facility during test sharp device seriously injury i wake up DR state that we dont have enough Anasthesia for this two test result patient wake up early struggle and movement cause injury.I am having serious major medical issue now.I am having breathing problems,swallowing disorder,esophagus spasm,cervical nerve disorder,perforation cause Mediastinitis complications cause nausea,throat pain,chest pain,throbbing pain back nerve pain,headache,dizziness,belching with gas bloating,when gas pass up at throat severe pain and chouk struggling shortness of breath.Loss of weight after injury also immune symptom damage dogent produce nutrison .Severe Dysphasia symptoms cause narrowing esophagus result two endoscopy with Dilation during 2017 also further appointment for endoscopy with Dilation on 8-24-17.After my injury every couple month two to four CT scan,lots of pain full test over and over but my condition getting worst.Please advise me how to survive and thank you for your help in this matter. Yash Patel

  • I had my first rib removed in 1985 thoracic outlet syndrome surgery and I am having major medical issues now! I am having breathing problems, my food want digest properly and throw it up every time I eat.
    But the VA Medical Doctors want admit that my problems coming from this surgery but keep giving me the same tests over and over again wish keep coming back normal!
    But my conditions is getting worst!
    What or if it’s anything I can do to get more compensation for this mess?
    Please advise and thank you for your help in this matter.

    Charles Waller

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