Medical errors: Honesty is the best policy

Monique Tello, MD, MPH

Contributing Editor

“It’s a definite that you’re all going to screw up, but it’s not a definite that any of you will learn from that,” declared one of our medical school instructors, years ago. “Cultivate the attitude that allows you to own your mistakes, and then, not repeat them.”

How common are medical errors?

Medical errors are, frankly, rampant. A recent study used data analysis and extrapolation to estimate that “communication breakdowns, diagnostic errors, poor judgment, and inadequate skill” as well as systems failures in clinical care result in between 200,000 to 400,00 lives lost per year. What this means is that if medical error was a disease, it would be the third leading cause of death in the United States.

The article is specifically about fatalities secondary to medical errors, and how these are vastly underreported. They point out many reasons for this, the first being that cause of death on a certificate is usually listed as the physiologic cause of death. For example, “myocardial infarction” may be listed as cause of death for a patient who was sent home from the emergency room with chest pain and a diagnosis of acid reflux. We have no direct way of knowing that their fatal heart attack was due to misdiagnosis.

In the course of my training over a decade ago I saw many errors, such as a punctured lung during central intravenous line placement in the intensive care unit, postoperative morphine overdose requiring emergency intervention, cancer seen on an emergency room CT scan and never reported to the patient… I could go on. What was most common then was a culture of silence: there was not consistent nor complete disclosure to the patient. People would whisper about mistakes, never directly addressing the issue for fear of litigation, or even retaliation by the involved physician.

Preventing medical errors—and learning from the ones that do occur

As the BMJ article authors point out, we can’t develop safer healthcare without identifying and analyzing medical errors when they happen. They call for a national database of medical errors, so that the information can be compiled for quality improvement and prevention research.

Thankfully, I now work at an institution that recognizes this, and openly embraces errors reporting. We even have an easy-to-use online safety reporting system which my colleagues and I have used many times, for everything from blood test tubes being sent to the lab without labels, to the wrong vaccine being administered, to falls suffered by our patients while in the hospital.

Worried that these types of reports reflect more mistakes being made than normal? Think again: as the data supports, the vast majority of medical mistakes simply go unreported. The true number of medical errors, both fatal and non-fatal, is unknown. What we do know is that healthcare delivery cannot improve if these are not examined.

How does this work? I can pull an example easily from among my own recent mistakes:

A lovely patient of mine* in her late forties complained of fatigue, depression, and body aches, which I attributed to perimenopause and arthritis. She did have slightly elevated calcium levels, but I didn’t think much of it. I blamed it on her calcium supplements.

After more than a year, we finally discussed checking her calcium level OFF of supplements, and lo and behold, it was still high. We discovered that she had hyperparathyroidism, an overactive parathyroid gland that causes calcium to leach out of the bones. Indeed, hyperparathyroidism and high blood calcium levels can cause fatigue, depression, and body aches, among other things that she had, such as osteopenia (weak bones).

She asked for a referral to a surgeon and had her overactive parathyroid gland surgically removed. Her complaints resolved within a day after surgery.

I apologized for my error which had resulted in a delay of diagnosis of about two years, during which time she had not only felt awful, but also developed weakened bones. I offered to facilitate her transfer to a new primary care doctor. She declined, and said that she was appreciative of my honesty in discussing the error, and hoped it could serve as a valuable lesson.

I shared this error with my colleagues and in the system. I, for one, will never let any slight elevation in calcium go uninvestigated, and my colleagues have learned from my example.

My med school instructor was right: if we don’t own our errors, we are destined to repeat them. In medicine, honesty is truly the best policy.

*This is a real case, without identifying characteristics. I have obtained the explicit written permission from this patient to discuss the case in this forum.

Comments:

  1. Hospital transport marlboro

    Good writing. Keep up the good work. I just added your RSS feed my Google News Reader..

  2. Maryalice Tilley

    Informative article . I learned a lot from the information – Does anyone know where my business might grab a sample NY DOH-4359 version to complete ?

  3. BBuchanan

    I would like to say, “Thank you”, for writing this arricle. I think that there are so many Dr’s who have been conditioned by the old school medical system into being scared to admit their mistakes for fear of legal action, which is truly sad and benefits no one.

    I know from personal experience (just one of a couple I could point out), my Allergy:Immunology Dr’s made the mistake of giving me the same booster shot twice. Although this was in no way a danger to my health in the gramd scheme of things, still in this instance it was an error and one I pointed out, unfortunately, I did not catch it & question them about it until after they had administered it. At which time, I watched them almost fall over themselves and attempt to down play that a mistake had even happened. In the end, I know they had made an error, and my Dr eventually admitted to me they had made an error (after some time had passed & they were more comfortable of my intentions, which were that I had no intentions, as I realize that some times errors happen, and if they cause no harm, then for me, it wasn’t a big deal), and as I already stated, that once they figured that out, and I had reassured them that it was alright, No Harm, No Foul, errors happen (so, basically, I wasn’t going to run out and try to file a law suit), We were all able to move forward. I’ve had Dr’s prescribe medication for me that contained sulfur, to which I am HIGHLY sensitive and allergic. My Dr did not catch it, my Pharmacy did not catch it. Both of whom have it on record that I am highly allergic. And had I not caught it myself (looked up the new medication in the PDR), I could have take it and it caused me a reaction ranging from mild to anaphylactic shock. I pointed the lapse out to the pharmacy and told them I would not be picking it up, and I contacted my Dr’s office and explained the issue to my Dr’s nurse and requested they send in an alternate that did not include the sulfur to which I’m allergic.

    My point is, 1) Patients need to take an active role in their health care, and to not always blindly accept a diagnosis, or a new medication (particularly if they have severe allergies), it is far better to be careful, get a 2nd opinion, or 4th, or 8th, until you the patient is comfortable with your treatment. 2) If an error does happen, depending on what and the level of the severity, as a patient, I would MUCH rather a Dr own up to it, than me have to catch it/point it out. i personally have more respect for any Dr who owns up to a mistake or error. I know that I feel far more comfortable knowing that in the future if something happens, my Dr will come to me and let me know, so that we can discuss it, then treat or correct it, and both move forward, together, as partners in my healthcare. It is an uncomfortable place to be as a patient, to feel like an adversary to your Dr, because of something as silly as a simple error/mistake, that resulted in little/no harm. Sadly, it does happen, and I have changed Dr’s because of it, because if my Dr can not be honest when treating me, than where will that put me if something else happens in the future? Because life & mistakes happen, we’re all human and medical care is not always (or ever really) an exact science. Dr’s can narrow things down, they can run tests to confirm, they can treat with medicine or surgery or whatever, but the outcome nor diagnosis is never a guarantee until the treatment works and time shows all of their attempts fix/correct the problem.

    Again, Thank you for this article, and because of your honesty, I would be happy to have you on my heathcare team! Hopefully, your attitude (& that of your heathcare system) will catch on and become the more popular method of approaching patient care in the future. I think healthcare providers historically, do not place enough value in such honest approaches, and they fail to realize how much value patients place in finding/having the choice between picking a Dr who you KNOW will be honest with you no matter what, versus a Dr that isn’t or may not be fully honest if they make an error. I would bet that 99% of patients would even pay a premium to go to the “Honest Dr”, who has made a mistake & owned up to it versus a Dr whose track record is unknown to them, (even if it is one they have been seeing for years)….that’s my view anyway.

  4. Nuruzzaman

    Great topic it was very helpful for me. However, Please give me one suggestion for me how can we reduce our fatal heart attack from heavily healthy problem?

  5. Janice clardy

    My brother had a nuclear test they were checking for staff.
    When he came out of the procedure he had a c pac on his mouth I ask the nurse why she said he was having trouble breathing. I said he was ok before the procedure . So I insisted they call rapid response and they did.When they came in they put tube down his throat . He had two liters of blood in his chest cavity. He is asthmatic he takes q var and didn’t rinse afterward. What I’m want to tell you is people are dying because they don’ t get a chest ex ray after his procedure . I have two people say that they have relatives who were on q var also died . My brother didn’t die because I was there and insist on rapid response. HAVE EXRAY AFTER NUCLEAR TEST

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