Vol , Issue Date of Publication: April 01, 2009
DOI: https://doi.org/10.20529/IJME.2009.040

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CORRESPONDENCE

DOI: https://doi.org/10.20529/IJME.2009.040


Disclosure of medical errors

The present letter is the author’s reaction to the recent increase in incidents of public intolerance to negative outcomes in medical care that have been reported in the media and press from all over the country. On many occasions these have been followed by retaliatory strikes by health care workers resulting in suffering and even loss of human life in some cases.

To err is human and to forgive is divine. Since the inception of medical science, human error has been an irremediable truth of history. Medical slips have been reported across the world, but for every reported error there are several that go unreported. Increasing litigation rates have been reported from all over the world indicative of deteriorating doctor-patient bonds and decreasing patient forbearance towards an inexact science and uncertain practitioners. Although the litigation rates are not as striking in India, instances of patient-physician conflict coupled with public intolerance have been surfacing with alarming regularity in recent days, in forms of mob violence damaging public and private property. Disclosure is no more a matter of moral righteousness but a blame and shame game.

The multiple factors influencing disclosure make it a complex domain of human behaviour, rather than an issue governed by scientific guidelines taught in classrooms. Moreover, medicine being a vague science, it remains unclear when an adverse event becomes an error worth disclosure. Fear, guilt, risk of harm and retaliation, all depend on the outcome of error and peak when fatal (1, 2, 3). Many years ago, my friend’s father succumbed to a nosocomial endocarditis, following catheterisation, and I have debated to this day if disclosure would serve any purpose beside rectitude, shifting the blame from the inadequacies of medicine to the hospital in question. I wonder if it is better not to know that a doctor’s error killed my mother or to continue to feel focused guilt, anger and frustration thinking that my timely intervention could have saved her.

Although honest and able communication remains the cornerstone for reduction of controversies and allowing patients an opportunity to forgive and forget, yet scarcity of time coupled with fear of a backlash, not to mention poor communication skills, are common on the part of doctors as they struggle with the silent conflict to inform or hide actual details. Despite numerous simulation studies, it remains to be seen if the evidence generated from in vitro studies would hold in vivo practice where judgment is to be weighed not against the whole truth but against the patients’ perception of the events (3, 4). Finally, although evidence indicates that candour reduces chances of litigation, as Gallagher et al have pointed out, yet the question remains, “How many of us believe it?” (5)

Ashish Goel, Senior Research Associate, Medicine, AIIMS, New Delhi 110029 INDIA email: [email protected]

References

  1. Hebert PC, Levin AV, Robertson G. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ. 2001February;164(4):509-13.
  2. Mazor KM, Reed GW, Yood RA, Fischer MA, Baril J, Gurwitz JH. Disclosure of medical errors: what factors influence how patients respond? J Gen Intern Med. 2006;21(7):704-10.
  3. Schwappach DL, Koeck CM. What makes an error unacceptable? A factorial survey on the disclosure of medical errors. Int J Qual Health Care, 2004;16(4):317-26.
  4. Cohen JR. Future research on disclosure of medical errors. Ann Intern Med 2004;141(6):481.
  5. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA 2003;289(8):1001-7.
About the Authors
Senior Research Associate
Medicine, AIIMS, New Delhi 110029
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