Living with your mistakes (MEDICAL ECONOMICS SPECIAL SECTION)

April 1, 2007

The stiff-upper-lip approach to dealing with medical errors doesn't help your practice, your patients, or you.

Key Points

Several years ago, a California internist saw another physician's patient-a heavy smoker with severe chronic obstructive pulmonary disease (COPD). "A chest x-ray showed a suspicious infiltrate and I ordered a CT of the chest, which showed a lung mass suspicious for malignancy," says the internist, who requested anonymity. "A biopsy was positive for cancer, so the hospital scheduled a lobectomy. But because the patient's pulmonary artery was damaged during surgery, she ended up having a pneumonectomy."

The patient, who lived for several years after the surgery, nonetheless sued the internist, as well as the pathologist and the surgeon, claiming misdiagnosis, surgical error, and debility from the pneumonectomy. "Even though I was dropped from the suit, the episode was a months-long nightmare," the internist recalls. "Not only was it the first time that I'd been sued, I felt guilty and wished that I had gotten a second opinion from a different pathologist and surgeon."

Another internist, who also requested anonymity, maintains, "One of the hardest things about being a physician is the weight of responsibility we shoulder when caring for patients. And when things go wrong, that burden only gets heavier. I've spent months haunted by 'what ifs' and deep regret over medical decisions that become much clearer in hindsight. Had I known that these experiences were part of being a doctor, I might not have chosen this career path, despite its many rewards."

In recent years, however, physicians' advocates have made the case that a damaging medical error-even if the patient recovers fully, and even if no lawsuit is forthcoming-often has an emotional impact on the physicians involved. In response, hospital and practice administrators, and even some insurance companies, have put mechanisms in place to help doctors cope with, and get past, missteps. If you don't have access to such a program, there still are things you can do to handle the distress of not living up to your own high standards.

Overcoming the conspiracy of silence

Coping begins with the frank acknowledgment that, in a 30- to 40-year career, you're going to make mistakes, despite the fact that society demands perfection from physicians.

"The goal is to make as few mistakes as possible, rectify them as quickly as possible, and face up to what went wrong so that you can take corrective action," says David Posen, a family physician who is now a stress management consultant in Ontario, Canada. "A mistake should upset you, because it often means that someone got hurt. But it shouldn't overwhelm you to the point that you're unable to do your job. If you make a mistake and don't acknowledge it, you nullify the possibility of fixing anything."

Physicians spend inordinate amounts of time replaying mental tapes of what happened and dwelling on what they could have done differently, says medical sociologist Richard Frankel, a professor at the Indiana University School of Medicine. Like Posen, Frankel insists that if you don't share your anguish over a mistake, you negate the possibility of understanding what happened. Instead, "what we often see is fear of reprisal or closing ranks," says Frankel.