Learning to Say “I’m Sorry”

Medical mistakes have been receiving a lot of attention in the last few years.  The number of patients injured due to medical mistakes, especially in hospitals, has caused pressure at every level of health care to reexamine how patients can be protected.  Many of these error prevention measures are technical – computerized drug interaction checking, pharmacy algorithms to prevent dispensing medications to which the patient is allergic, redundant verification of critical pieces of information like the side of a surgery or the blood type.  These technical procedures go a long way to prevent catastrophes, and more of them are being adopted all the time.

But what about after an error has already occurred?  What about after a patient has already been harmed, not by her disease, but by a mistake?  This week’s New England Journal of Medicine has an important perspective article on the toll of medical mistakes on patients and families.  The article was also covered in this story in today’s New York Times.  The authors interviewed patients, family members and physicians that were involved in medical mistakes.  They found three unifying themes to many of the interviews:  family members feel guilty for not protecting their loved one from the medical error, family members and patients fear retribution from health care workers if they express themselves about the error, and physicians frequently isolate and cut off communications with the patient and the family after an error occurs, when the family feels most vulnerable.

Many institutions are learning from these lessons.  Cedars-Sinai has been quite aggressive in assuring prompt and full communication with patients and with families after errors occur.  As part of their Leadership Development Program, I’ve worked closely with their risk management department and have heard their commitment to prompt and full disclosure of errors.  Cedars-Sinai recently has also adopted the practice of not charging for any care that is needed to recover from a medical error.  So if a hospitalization is prolonged or an extra surgery is needed to repair harm done by an error, Cedars will not bill for the additional care.  They are also working on a curriculum which will be available to all the residents and medical staff about “having a difficult conversation” which will train doctors to compassionately have the discussions we all dread:  to break the news about a terrible diagnosis, to convey an unexpected outcome, to admit a mistake.

A business coach once taught me the motto “Systematize the predictable.  Humanize the exceptional.”  This applies particularly well in medicine.  To prevent errors we have to use technology to systematize the thousands of daily routines that keep hospitals running safely.  But once the error has happened technology is useless, and we must be guided by the goal of restoring trust, respect and compassion between human beings.

Tangential Miscellany:

Two weeks ago a lot of you emailed me about the outrageous ways that doctors or their offices have annoyed, inconvenienced and disregarded you.  I’m trying to collect lots of these anecdotes, and your stories may actually prevent similar things from happening to future patients, so please keep the emails coming.  (I’ll let you in on what this is all about as the project ripens.)

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