31 July 2005

Can a Doctor Say "I'm Sorry?"

While driving yesterday, I overheard a man in the radio complaining about medical management in a hospital where he had her pregnant wife admitted because she was about to deliver their second baby. His wife was admitted at 5 cms cervical dilatation and monitored for labor developments. Medical residents attended to his wife, and there was no mention of where the attending physician was.

His wife went under the supervision of two medical residents as their stay covered the time where the medical shift occurred. From his story, he related that everything seemed okay with the monitoring done by the first medical resident but when the second resident took over, that was where the troubles began. The second medical resident was the one who noticed that there was massive vaginal bleeding and that the baby's heartbeat can no longer be appreciated. Even with Doppler ultrasonography, there were no heartbeats appreciated. At this point, he was contacted by telephone by the attending physician who was similarly puzzled at the development because it seemed pre-natal check-ups didn't detect anything abnormal about the pregnancy.

'Looks like another case of medical negligence, but that might be jumping the gun as I wasn't able to get the complete story. I lost the radio signal once I entered the parking lot. But it made me think. My first clinical impression from the brief story is undetected placenta previa, but as I said, I may be wrong.

That scenario is a prototype of hundreds, perhaps thousands of medical admissions that happen everyday in the metropolis. The frontliners are always Medical Residents. Attending physicians enter the picture only depending on the severity of the patient's condition. It is imperative that Medical Residents are competent. Familiarity with the consulting patient's history is almost always an impossibility because oftentimes this is the first meeting between the Medical Resident and the patient. If the case is life-threatening, and the attending physician is nowhere to be found, the scenario can really become very messy.

Like other doctors, I'm not immune to medical mistakes myself. I have my share of bloopers also. The only thing I'm thankful for is that none of them have been fatal. I've heard of many stories about medical blunders like the one my medschool classmate told me when he admistered a phenobarbital bolus IV dose to a non-convulsing patient who wasn't supposed to get it in the first place. He was so tired and sleepy when he committed that mistake.

Last week, I came across a NYTimes essay by Dr Richard Friedman who bemoaned a doctor's inability to apologize:
Not long ago, a patient called me to complain about the treatment she received from one of the residents I supervise. After starting a new medication, this patient said that she experienced bad side effects, and that her doctor had failed to warn her that this drug might interact adversely with other medications she was taking, something she discovered by herself on the Internet.

What really bothered her was not so much the physical discomfort --- headache and dizziness --- but the fact that when she confronted her doctor, a psychiatrist, he didn't apologize for his mistake. She asked to be switched to the care of another resident, because she felt her current doctor would resent her for taking him to task.

When I reviewed this case with the resident, he puzzled over why he was reluctant to apologize to the patient. Did he feel his medical authority was threatened? Was he worried about the legal implications of admitting a mistake? Not really.

Instead, it seemed to the resident that acknowledging the mistake would narrow the psychological distance between him and his patient, and that felt uncomfortable.

Everyone assumes that the ever-present threat of litigation has made doctors more anxious about admitting error, and no doubt it has. But doctors have always been tight-lipped about their mistakes, in part to preserve an illusion of medical omnipotence.

[ Learning Words They Rarely Teach in Medical School: 'I'm Sorry', Jul 26 2005 ]

Dr. Friedman mentioned that there are studies that show that patients seldom sue when doctors apologize for their mistakes. He says there are 16 states in the US where doctors become legally immune to suits when they apologize for their mistakes.

Here in the Philippines where the Medical MalPractice Act and Patients' Rights Bills are still bills awaiting deliberation in Congress, medical mistakes likewise happen every day. Doctors will always try to act to save lives, but like any other human, they are prone to unintentional mistakes. We have always made a stand that the proposed bills in Congress and the Senate, should they be passed into law, will only harm the doctor-patient relationship, and further drive medical costs up. But I think such bills were proposed because patients and patients' relatives are getting less apologies from doctors when they commit mistakes.

Saying sorry is difficult to do especially if most doctors would like to preserve their respective reputations of "medical omnipotence" --- the concept of mga diyos ang doctor sa lupa at hindi nagkakamali (doctors are gods on earth and cannot commit mistakes) --- but I believe we have to start somewhere in order to build more trust between patient and doctor.

We cannot be forgiven if we don't admit our mistake and apologize. Healing is an art but so is being humble and saying sorry when you commit a mistake.

8 reactions:

rolly said...

Doc, I can understand the nobleness of the gesture of the doctor apologizing but I don't think people would be that forgiving when the error committed to their loved one is fatal. This is one apology I don't ever want to hear from my doctor or I might become hysterical. Even just thinking about it makes me shiver.

may said...

let's all go ahead and say sorry.it will save us and everyone else a lot of pain and trouble.the doctors find it hard to say sorry? why? are they not human and never commit mistakes?

Anonymous said...

I went through 12 hours of labour before my doctor realised the baby was breach & recommended a Caesarian. Ok, these things happen. But the doctor was very candid with me and said, "I could tell you that the baby turned very late in pregnancy. But probably I just missed it. I'm sorry.' Made a huge difference.

Anonymous said...

Unfortunately, in this litigeouls society, we are counselled that saying "I'm sorry" may be construed as an admission of guilt, whethr it be a fender-bender or a bad patient outcome. I've said it a few times & the world has not fallen down in pieces. But, all the literature from the medical societies discourages this pracitce. Crazy!! And then they wonder why we docs are so distant.


BabyPink said...

a doctor's saying i'm sorry is a proof that s/he really made a mistake. and, knowing that we usually trust doctors so much or we entrust our lives and the lives of our loved ones to them, i don't think we (ordinary people) would like that at all. this is because we would that if the doctors themselves commit mistakes and cause bad consequences, who could we go to, then, when we have health problems? it would make us really reflect about trusting doctors.:)

Dr. Emer said...

Tito Rolly: But those things happen, Tito Rolly. Whether or not the mistake is fatal, it happens. And I think it is more painful if no apologies are heard. Whether or not it makes a difference.

May: We are all human like everyone else. But because we handle something as fragile as Life, we always work under the veil of high expectations.

Anonymous 1: Did the apology make you feel better?

Anonymous 2: Yes, too much suits gave birth to the term, "defensive medical management."

Baby Pink: Well, doctors are not Gods, my friend. Sad as it may be, mistakes do happen. Apologizing won't correct the mistake of course, but would you prefer not to hear any apology at all?

BabyPink said...

doc, i was speaking not for myself, but that's how i see some people, if not most people, think about this "issue". i used "we" in the same way that "you" is usually used.:)

ting-aling said...

This reminds me of my own case. I was misdiagnosed over 10 years ago and the surgeon found out that she was wrong right there on the operating table. She apologized to me right there and then. This was probably one of the reasons why I opted not to sue, although suing would be my last recourse. I don't think that I even have the heart to sue.

That trumatized me and I put my case in the shelf until it became worse. The thing is, when I went back to my GP, he recommended me to the same specialist. The second time around was much, much better to the point that I thought it was an overkill. I had second opinion, even third opinion, looked at by 2 different surgeons to make sure that they agree with her diagnosis before she went ahead and opened me again.

She admitted after I recuperated that although it was an overkill, she was thankful that I did not take it against her and that she owed me due diligence, after what happened the first time. She said that she does not normally do this with her other patients.

Moral lesson? Doctors are human too and they ought to not be afraid to admit it. Afterall, it would be their conscience that will go after them in the long run.