Medical Associates Clinic

 Quality Care Close To Home

Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
8 June 2005

THE PROBLEM OF MEDICAL ERRORS

            If one makes an analogy to a baseball game, periodically even the very best players will make an error.  A ball will go between the legs or a throw will go wild and a game is won or lost.  Fortunately for those baseball players, there are no lawsuits for industrial amounts of money.

            The situation is quite different in medicine.  Any medical error regardless of the consequence is grounds for a suit against the personnel and facility in which the error occurred. Very substantial amounts of money are spent on diagnostic tests to insure and re-insure that diagnoses are correct and that medical treatment programs are on target.  But what is the appropriate responsibility of a medical personnel when they make a mistake?  How do they explain that to the patient or their loved ones?  Many times such as the case described below, there is now way back.  The results of the error cannot be undone.  What does the family want to know and to hear at that point?

            This is the story of a gentleman 56 years old who had been a lifelong smoker.  He paid little attention to his health not having seen a physician for 20 years.  He came to the ER have a hospital with severe abdominal pain.  In short order, he was diagnosed with having a ruptured abdominal aortic aneurysm.  He was dying.  By luck alone, the chief resident in vascular surgery happened to in the emergency room at that moment.  He himself virtually wheeled the gentleman to the operating room within minutes.  They had anesthesia ready and an immediate incision was made in the gentleman’s abdomen.  The bleeding aneurysm was isolated and his life was saved after extensive transfusions.  This was the miracle of miracles.  Bleeding abdominal aortic aneurysms carry over a 90% mortality.  Through the diagnostic skill of the physicians and nurses in the emergency room and the surgical skill of the chief vascular surgeon, this man’s life was saved.  After he was stabilized in the operating room, he was taken to the recovery room of the hospital where there was anesthetic effects.  He needed an artificial respirator for a short period of time to maintain his breathing.  Unfortunately, the connector piece the artificial respirator and the gentleman’s endotracheal tube dislodged.  In the commotion of the recovery room it was not discovered for several minutes.  The gentleman had a cardiac arrest and died.

            In the analysis that followed, it was recognized that a simple alarm system that was not present might have alerted the staff in the recovery room to the mistake.  Just the month before, the hospital’s Safety Committee, had ruled that the alarm systems were not reliable and not “cost effect”.  I was still a physician-in-training at that time and not an interval part of the case.  I never knew what the doctors or the nurses said to the family or whether there was any litigation that followed.

            In surveys in patients for whom medical errors had occurred, they overwhelmingly express a desire to know that an error was made and they inquire about how and why the error happened.  Moral ethical behavior requires that patients be treated in a fair and equitable way and informed regarding their diagnosis, prognosis, and care.  But it is not that easy.  Many times, medical errors are of no consequence.  What if a patient receives an extra pill that is of no consequence.  In the strictest sense of the word, this is a medical error.  When patients are informed of such, competence in the personnel and system of care is undermined.  This may not be in the patient’s interest at all especially in critical situations where most errors occur.  By the fact that litigation may follow disclosure of a medical error, the medical system and the patient become adversarial.  By the very nature of that relationship, full disclosure is impaired.

            In surveys inquiring about what patient would like to know when a medical error occurs, the following errors occurs. 

            The following information was obtained: 

            1.  Patients wanted to know when a medical error occurred whether it actually caused harm or was simply a near miss. 

            2.  They also wanted to know how a recurrence of this type of error would be prevented.

            3.  The majority wanted an apology from the healthcare providers.

            4.  80% of respondence felt that any fee for the service provided should be waived. 

            5.  Patients wanted to know what type of compensation they would receive because of the error.          

            6.  Some of the patients wanted to be referred to another healthcare provider.

            Several large national healthcare organizations had endorsed a policy of full disclosure when medical errors have occurred.  Bioethics also demand that patients be fully informed of medical errors.  Speaking for myself, I agree with that position.  But patient should realize that following this very high bioethic standard, does not necessary result in benefit to the patient.  Undermining the competence and the whole healthcare system is an intrinsic part of medical error disclosure.  For the errors that might ever occur, the benefits far outweigh the consequences of medical errors.  Errors are never done with intent.  But no system, medical or otherwise is perfect and errors will occur.  A discussion with your healthcare provider on what you would prefer to know can be helpful in fostering a relationship that is trusting and beneficial for all.