Aug 25 2007

Doctors: Apologize for Euphemistic Unanticipated Outcomes

Doctors at the University of Illinois Chicago Medical Center are being encouraged to admit medical mistakes and apologize to their patients, so states an article by Judith Graham, published in this week’s Chicago Tribune.

Good! And I can’t state that strongly enough.

I’ll add, it’s about time, so what took so long, and one down — what about the other 6,499 hospitals in the US? (OK, a few encourage apologies — see below.)

Ms. Graham did an excellent job with the article. She presents the many aspects of the history of physician apologies, why doctors have, or haven’t, apologized over time, and provides very substantive quotes from various experts in the field. In effect, egos and fear of retribution in the form of lawsuits have stood between physician mistakes and patient communication over time.

No surprise there.

A few points stand out from the story — worthy of being shared. First, that the Veterans Administration and hospitals affiliated with Harvard Medical School encourage their staffs to tell patients about errors, provide an apology — and (very importantly) explain what they will do in the future to prevent a similar mistake. As someone who has been burned by a medical error, I can very much appreciate that approach. I may have suffered, but I can feel a bit better about it if I know they will take steps to be sure it doesn’t happen again.

Second, that the Joint Commission on Accreditation of Healthcare Organizations (the group that oversees the credentials of hospitals, formerly called JCAHO) also encourages fessing up. That’s good, too.

But in the midst of the Joint Commission’s recommendation, they have also developed a new euphemism for medical errors. Honestly — this is so ridiculous, it made me laugh out loud! God forbid we should call a medical error spade a spade — they now call them “unanticipated outcomes.”

What a cop out! Medical mistakes are not “unanticipated” outcomes at all! Mistakes are just that — mistakes. If a doctor makes an incision in the wrong place, there is nothing unanticipated about it — it’s just a mistake. If a doctor prescribes the wrong drug or the wrong dose of the right drug, there is nothing unanticipated about it — it was just plain wrong. If a doctor misdiagnoses or orders the wrong treatment — it’s an error, plain and simple. If a doctor doesn’t stop to wash his hands, and his patient acquires an infection — c’mon — it’s not at all “unanticipated!”

And — when any provider makes a mistake, s/he can most certainly anticipate the outcome! S/he can anticipate that it will cause a problem for the patient. S/he can anticipate that the patient will take longer to heal — or might even die! S/he can anticipate that the patient and his/her family will be upset. And on and on.

OK — you’re right. Nobody plans to make a mistake. But that doesn’t mean the mistake was unanticipated. No way. So — Joint Commission — why don’t you call a medical error exactly what it is? It’s a medical error!

All this reminds me of that book that came out about 20 years ago about everything I needed to know I learned in kindergarten. My parents (and kindergarten teacher) taught me to be honest, to come clean about mistakes and above all, to apologize to the person I wronged. I wasn’t allowed to use my fear of punishment as an excuse, and certainly I was never allowed to let my ego get in the way…. not a chance….

So, doctors — you have absolutely no reason to cover your backsides by non-communication and lack of apologies any longer. Big name organizations are providing this message — no matter what they call a mistake or — excuse me — an unanticipated outcome — apologize and communicate!

Patient trust is already tentative at best. Non-communication is no longer acceptable, regardless of whether it’s your ego or your insurance company whispering in your ear. Stop making excuses, stop covering up, stop pretending the consequences of your errors were “unanticipated.”

Be human. Be apologetic. Be humble. Be available. You’ll sleep better, too.

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Note: see follow up post: Did My Doctors Apologize?

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2 comments

2 pings

    • PalMD on August 25, 2007 at 10:11 am

    We need a nation-wide system for error reporting. The current malpractice and litigation climate makes it very difficult to do a good job, and systemic problems cannot be fixed without acknowleging them.
    I recall vividly the VAs approach to problems when I was a resident…it was very transparent.

    • dxunknown on August 25, 2007 at 9:43 pm

    If my feet weren’t hurting so bad, I would stand to applaud this post! “Unanticipated Outcomes?” The only situation that should apply to is when a doctor actually DOES appologize for something he/she did wrong! Now THAT is unanticipated!

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