Owning up to medical errors

Roger Ladouceur

This month, Jacobs et al ( page 271) tackle the question of medical errors and the undesirable events that arise from providing care. This subject is worrying because we estimate that 1 person in 13 is victim of an undesirable event and that 7.5% of patients hospitalized for a short time suffer harm of some kind.

Obviously, problems with care and the consequences they engender vary in severity. Some are no more than incidents. Other events are very serious: administering a medication to which a patient is allergic or prescribing a contrast product to a patient with renal insufficiency can have severe consequences. Some events are catastrophic: amputating a healthy organ or forgetting surgical instruments or sponges during an operation can have irremediable consequences. In Canada, an estimated 10 000 to 20 000 people die each year of complications related to care given during short-term hospitalization.

Nobody likes to hear these numbers, least of all physicians who are often held responsible when things go wrong. Many physicians try to protect themselves by avoiding risky situations or by referring patients. Rather than infiltrate the arthritic knee of a suffering patient, they send him to a specialist. Obviously, for the patient, the consequences are very serious, but they often pass unnoticed. The arthritic patient endures his pain without anyone taking the blame. The solution to managing these problems of care is certainly not to flee from them. When all is said and done, most adverse events are multifactoral in nature and indicate that systemic changes are needed.

When a doctor is implicated in an incident, particularly if the consequences are grave, the best approach is definitely to inform the patient and his or her family directly. Nothing is worse than for a sick person to hear from outside that he or she has been the victim of a medical error. Facts can become grossly distorted. Physicians should inform patients, no matter what caused the events, of the facts and the nature and circumstances of the problem while expressing regret and showing sympathy for the situation.

Even though we know better than anyone that we should first “do no harm,” and despite all the improvements we make to the quality of medical care, we are human, and errors will continue to occur. And when they do, we should remember the old adage, “A fault confessed is halfway pardoned.”