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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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  • This is a revealing article. I myself believe that disclosure avoids most litigations. Still the doctor should use legal terms so as to avoid inadvertent case in court. Given the fact that no judge ever understand the wide range of possibilities in outcome after any treatment protocol, still error reporting with peer consensus should be a new standard of care.

  • The system does not encourage learning from mistakes. If a doctor admits to making a mistake, the response will not be “This is what you should learn from it”. Instead it will be “This is the end of your career, your house and your kids’ future”. It becomes far safer to hide errors than admit to them. If a doctor hides an error, there is a small chance he/she might get away with it. If they admit to an error, that is basically suicide. Dr Schlachter and his advice is the real problem here. Instead of encouraging a learning culture, he is encouraging patients to distrust doctors and blame them when things go wrong (at least in this article; he may well express different advice elsewhere).

  • I never heard of a superman, superdoctor who did not have a mistake. Unfortunately I am human Doctor. But on the other hand , some Patients and Lawyers are
    just waiting for any mistake to conclude the direct relationship to death and suffering. Maybe we should sue God at one point of time.

  • I came into work one morning on a psychiatric unit to discover one of my patients, a young man, was coding. I had admitted him only the day before. He subsequently died. Later in the day I contacted his family, and expressed my condolences and sympathy. The next day I was called into the medical director’s office and told that I should not have had any contact with the family. This blew my mind! It brought to ind my medical student days, when I rotated through a hospital in West Virginia and was told that recently a obstetrician had been successfully sued for an amount that was supposedly a record claim pain out for a malpractice claim. It was related that following a birth with a bad outcome, the doctor did not have any contact with the grieving family.
    No lawsuit resulted from the incident involving my patient’s death.

  • Recently, I was reading where people studying whether admitting mistakes lead to NOT being sued despite numerous states the don’t allow apologies from being admissiable in court where a malpractice case is being litigated found that if you are a primary doc your chances of being sued INCREASED. So much for legislation that supposedly was to make apologies protected from malpractice litigation. Maybe our turncoat colleague (notice he chose the plaintiff side) can offer a better explanation for why we should not be concern that our profession will be attacked by plaintiff attorneys after looking at these results?

    • Dr. Shaw,

      It is telling that physicians believe not admitting a mistake will somehow insulate them from legitimate liability. I’ve had a career as a medical malpractice attorney on the plaintiff’s side, and I can point to a number of cases in my career in which a physician committed fraud attempting to conceal facts pointing to mere negligence. In a few instances, this has led to consequences for the physician far more serious than simply admitting the error would have.

      I would ask physicians to consider that insurance covers nearly all medical errors, and that this is what it is for. Denying liability forces an injured patient to litigate for years, investing far too much time, emotion and money in an attempt to obtain rightful compensation. The system is cruel to such patients who often are refused treatment, once injured, by other physicians in their community. Admitting liability allows one’s patient a chance at prompt compensation and puts at least some small measure of their burdens in the right place.

      The very best physicians in this country seem to agree with me. I am sad to think that other members of this much needed and highly regarded profession have drawn Draconian lines in the sand against those who need them the most.

      I am old now. Having watched this drama play out over decades in California, where caps on what patients can recover in medical malpractice lawsuits have been in place for over 40 years, it is obvious that the standard of care in terms of patient safety has been lowered, especially in inland communities where the lesser lights of the profession seem to settle, and where the patients are less sophisticated. Our doctors know that there is practically zero likelihood of a successful case against them for violating safety standards (roughly 90% of the med mal cases that go to trial in most counties in California result in defense verdicts). Getting caught is a mere cost of doing business. It isn’t fun, but it isn’t going to ruin one’s career – unless one gets caught a lot.

      Physicians who feel besieged by the threat of medical malpractice lawsuits can reduce the risk of same by employing some humility, making sure their skills, knowledge and caring meet the standards, and treating their patients with genuine concern. The best do this anyway. Be one of the best.

      My $.02.

      Suzanne Mindlin

  • Re previous entry on January 2017 – CORRECTION: I wrote to help raise consciousness for those who do not understand we are in a major health crisis in this country – when 100,000’s of patients die each year from preventable medical errors – and many more who survive medical errors are left with disabled bodies and broken spirits to figure out how to regain quality of life.

  • Unfortunately, I am too familiar with everything Dr. Schlachter discussed regarding the BMJ report last fall that showed most physicians would not comment or apologize about medical errors. After entering a large teaching hospital for surgery and one overnight stay, I woke up weeks later in an ICU where I had been in a coma on a ventilator and undergone five surgeries, all because of medical errors, adverse events, and preventable raging life-threatening infections. No one thought I would live. But, still psychotic, I vowed to find out the truth and write a book. Somehow I must have known that no one would ever tell me anything. The hospital said not one word. The surgeon said minimal perfunctory words. I spent 8 years learning the truth and writing a memoir, which intimately portrays my struggles to survive and find justice. I wrote to help raise consciousness for those who do not understand we are in a major health crisis in this country – when 100,000’s of patients die each year from preventable medical errors – and 10,000’s of those who survive are left with disabled bodies and broken spirits to figure out how to regain quality of life. All of us must learn the truth and hold hospitals and clinicians accountable. Corporate profit must no longer prevail over patient safety. Hospital care must be performed with transparency. Each of us is a precious human being. We deserve better than what we are now getting.

  • I’ve practiced surgery for over 30 years and like all surgeons, have dealt with my share of complications including informing my patients of them. I speak as a surgeon with experience as a malpractice consultant and as a board member of a captive malpractice insurance company which covers the physicians and nurses in our health care system. I personally have never covered complications up, shifted blame or done any of the other egregious behaviors the author describes. In fact, we and virtually every other organization encourage physicians to be forthright and honest with patients and provide education and training to that end. This article is an obvious ploy to attract more malpractice business disguised as a concern for patients. How can you believe anything an attorney says about the matter who is paid on a contingency basis? The “culture” you refer to, to the extent it does exist is largely due to the occasionally unscrupulous, often over zealous efforts of attorneys who shop for experts who will tell juries what they want them to say because they see dollar signs in the suffering of patients and errors of physicians – most of which are neither negligence or malpractice.

  • I’m concerned with your use of the “Medical Error” study; as STAT has reported before[1], these errors are over-inflated and citing this finding without proper clarification creates a negative stigma against the medical profession and could ultimately dissuade patients from seeking medical care in fear of the danger.

    Of course, there are real dangers and the ethical responsibility of physicians is not being fulfilled as it should; we need to work collaboratively with patients and physicians, educating both of them on the issues and the importance of honesty–without this honesty, we create a dangerous, accusatory, and negligent culture.

    To paragraphs something I read, ‘there’s a difference between making a wrong decision, and making a decision wrongly.’

    [1] https://www.statnews.com/2016/05/09/medical-errors-deaths-bmj/

  • As a medical malpractice attorney whose livelihood depends on suing doctors, this author obviously has a biased viewpoint on the subject. In fact, this article reads to me more like an advertisement than an opinion piece. Like every attacker of the health care establishment before him, he cites the oft-debunked nonsensical 250000 deaths/year claim. He claims that fear of malpractice lawsuits is a “pretense”, but I’m quite sure an examination of Schlachter’s lifestyle would confirm that the fear of malpractice lawsuits is justified.

    Unwillingness to volunteer an admission to a mistake is hardly unique to physicians. It applies equally to auto mechanics, appliance repairmen, politicians, and even lawyers. How often does a lawyer come to his client, the losing defendant in a civil or criminal case, and point out that he forgot to check part of the relevant case law or contact a potential exculpating witness? Has Schlachter ever done that? Highly doubtful. But perhaps he’s just never made a mistake.

    The difference is in these non-medical professions, litigation is a minimal factor. I’d have a lot more respect for lawyers moralizing about physicians taking responsibility if they tied that to malpractice reform that could actually affect their own bursting wallets.

    • 250 k deaths per year has not been ‘debunked,’ and some leading authorities place the figure closer to 440,000 per annum. There is a major problem. Patients are paying the price.

      And who butters your toast, Rocky? You sound like a talking head for special interests yourself.

      I can vouch for everything stated in this article. I experienced diagnostic errors and NEVER received an apology. Years of my life robbed. I had the same PCP for NINE years. I adored her. I thought she would voluntarily apologize, she didn’t. She never acknowledged her errors at all. Instead, she went about covering up her negligence, even committing fraud in my EMR. What a disgraceful betrayal.

      I’ve since communicated with countless other patients online whom have been victims of medical negligence, the story line is consistent. Doctors are not accountable for their actions — they lie and will throw a patient under the bus in a New York second.

      Many states have apology laws but do providers use it? NO. Sometimes an apology is all that stands between peaceful resolution and healing vs an ugly and distressful lawsuit, but the system and culture is such as to drive a wedge between the patient and physician when an error occurs. Patients deserve an apology and they deserve fair recompense when appropriate.

      California has tort reform and a 250k damage cap which has not kept pace with inflation. Imagine having a child permanently brain damaged due to a negligent error, facing a lifetime of medical expenses and after all is said and done still ending up in debt just over legal expenses. Lawyers are leaving medical malpractice left and right in Ca. Injured patients cannot even find a lawyer in Ca unless they have damages far beyond the 250k cap for wage loss. Children, the elderly, and the poor simply do not have enough financial value for lawyers to represent them, so they lose. I suppose this is the goal.

      Further, patients stuck with arbitration face another impossible battle — the system is rigged against plaintiff patients who have less than a 20% chance of winning. And even if they find a lawyer, if the victim can’t afford upwards of 2 to 5k a day for expert witnesses, it’s over.

      Integrated, closed systems, such as Kaiser Permanente, force doctors to acquiesce to their legal team’s demands, no matter if they’d prefer to apologize and work out a reasonable settlement without exposing the victim to further emotional harm. If they don’t cooperate, they will lose the malpractice coverage afforded to them under their contract. So much for autonomy and fairness.

      Until you or a loved one are a victim, you can’t begin to imagine how horribly unfair and egregious the system is.

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