Medical errors trigger variety of powerful emotions in clinicians and patients

Following a medical error, clinicians and patients are often left with a range of strong emotions that could be resolved in a more satisfying manner with better communication, according to the authors of a commentary published in the Oct. 25 New England Journal of Medicine.

Tom Delbanco, MD, and Sigall K. Bell, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston, offer perspective gleaned from a documentary on the aftermath of medical error.

Following an error, patients and families often have three emotions that are under-recognized, the authors write. Families feel guilty that they didn't watch their loved ones closely enough to prevent an error such as the administration of a drug that they knew would cause a serious reaction, or that they didn't press clinicians hard enough to properly diagnose and treat a problem. Patients also fear retribution from staff or poor treatment in the future if they confront a health-care provider, and they feel isolated when clinicians back away and fall silent following an error.

Clinicians' cautious communications with patients and their families may be due to feelings of guilt, shame, legal concerns, or fear about their job security. To address these situations, they write, "First steps might include creating structured curricula for professionals addressing both error prevention and response, removing stigma from transparent reporting systems, and deploying a system of expert first responders who guide patients and clinicians when an error occurs."

Delbanco T, Bell SK. Guilty, afraid, and alone-struggling with medical error. N Engl J Med. 2007;357:1682-1683.