medical mistakes, medical error

There is a very clear code of ethics for the medical profession. Physicians and hospitals are supposed to fully disclose errors and adverse events. That is the policy of the Joint Commission which accredits and certifies roughly 21,000 health care organizations in the U.S. Many other health care organizations that protect the public have also endorsed full disclosure of medical mistakes or “serious unanticipated outcomes” (AHRQ-Agency for Healthcare Research and Quality, July, 2016). But new research suggests that many physicians probably ignore these guidelines (BMJ Quality and Safety, Oct., 2016).

Testing Doctors for Truthfulness:

Researchers sent questionnaires to 630 primary care physicians who were working in HMOs in Georgia, Massachusetts and Washington. Roughly half (333) participated in the survey and about 300 responses were included in the analysis. Most were seasoned health professionals, having practiced medicine for over a decade.

The Two Vignettes:

Delayed Cancer Diagnosis:

Everyone who participated in the study received two hypothetical scenarios. In one, the primary care doctor was asked to imagine seeing a 45 year-old woman with high blood pressure that had been well controlled. This was a routine follow-up visit for her hypertension.

During the visit the patient noted that a lump in her left breast seemed larger than it was six months earlier when she was seen by a colleague at the clinic. He had examined her breast but had not ordered a mammogram. No additional breast exam had been scheduled.

“A subsequent breast biopsy revealed cancer, with 3 positive axillary nodes.” The woman should have received a scan much sooner, but the colleague missed several opportunities to follow up.

Care Coordination Breakdown:

In the second hypothetical case, a 65 year-old man with hypothyroidism was being treated for colon cancer. He contacted the clinic a few times to report that he was feeling fatigued and was dealing with bouts of diarrhea.

He was reassured by a nurse. The nurse brought his calls to your attention and to the oncologist who was treating him. Both you and the oncologist assumed the other physician was following his case closely. Neither you nor the oncologist followed up. The patient ended up in the emergency room because he passed out on the way to the hospital. His hematocrit was 16. A normal value should have been 42 to 54. Someone dropped the ball.

The Questions:

Doctors who participated in this survey were asked how likely they would:

  1. Apologize for the mishandling of the cases
  2. Explain the reasons for the delay and diagnostic screw-up
  3. Describe the cause of the mistakes
  4. Reveal plans to prevent such events from happening to other patients in the future

The Answers:

One of the authors, Dr. Douglas Roblin, was quoted by Newswise:

“The intent to disclose was not as frequent as we thought it might be…The two vignettes gave pretty consistent findings. The majority would not fully disclose, and we were hoping for full disclosure because that is the ethical expectation.”

Results of the survey:

The authors found:

“A majority of respondents would not be fully forthcoming in either situation, providing only a limited or no apology, limited or no explanation and limited or no information about the cause. For the delayed cancer diagnosis vignette, a majority would provide limited or no information about efforts to prevent recurrences…”

Discussion

“Our study shows that, despite all the attention over the past 14 years to the importance of open communication with patients following error, full disclosure remains elusive. Most physicians would provide only partial disclosure after either of the events studied here. When asked what they would tell the patient about the cause of the error, 77% of the physicians for the delayed diagnosis of cancer case, and 58% of the respondents for the care coordination breakdown case, would offer either no information or make vague references to ‘miscommunications’. More than half of the physicians in both cases reported they would not volunteer an apology or would offer only a vague expression of regret. This limited approach to disclosure by physicians in this study falls far short of patient expectations and national standards.”

The People’s Pharmacy Interpretation:

We are not entirely surprised by these results, but we are disappointed. Please keep in mind that this study involved hypothetical case reports. It was not asking physicians whether they had actually made a mistake and whether they would report it to the patient or family. This was all hypothetical. In other words, “doctor, would you disclose an error if your colleague missed an opportunity to diagnose breast cancer in a timely fashion?” The majority said no, they would not fully disclose medical mistakes or apologize.

We have to wonder what the actual disclosure rate would be if a doctor actually did make a serious mistake either in diagnosis or treatment. We suspect that the report card might be even worse.

Ethical Expectations:

Here is what doctors have been told repeatedly they should do after medical mistakes are discovered:

  1. Provide full disclosure of all harmful errors
  2. Apologize and accept responsibility for the medical mistakes
  3. Explain exactly what happened and why
  4. Commit to preventing such a mistake(s) from happening in the future to others

Protect Yourself and Your Loved Ones:

Please forgive us for sharing a personal story. We lost someone we loved because of a series of medical mistakes at one of the country’s leading teaching hospitals. There was no disclosure of errors and no apology. Only after we discovered on our own that a number of medical mistakes had been made did hospital personnel provide additional details. Even then there was a reluctance to admit the hospital was at fault. We did not sue. We wanted to make sure no one else experienced similar errors. Sadly, this is not a message that has been welcomed. Are Medical Mistakes and Deaths Being Swept Under the Rug?

Are Medical Mistakes and Deaths Being Swept Under the Rug?

We did write a book to try to help others avoid the pain and anguish we went through. Here is a link to that publication should you wish to try to help family and friends avoid a similar tragedy. We provide lists of common errors, strategies for avoiding problems and ways you can prevent misdiagnoses. We hope this book will save lives.

Share your own story in the comment section below,

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  1. Faerie Dogmother
    Hawaii
    Reply

    This is so true of Veterinarians as well (responsible for 3 dog deaths in my circle recently). I’ve had both MDs and Vets lie to my face so many times, even though it was completely clear they had made an error (and still charged me for it). And when it’s your word against the doctors lawyers don’t even want to help you. I’m not sure I can even count how many times this has happened but I would say it’s probably more like 98% if the scenario was a real one, and the doctor was truly looking at real conflict. Now I see a Naturopath who addresses underlying issues with natural supportive and rebuilding options. No negative side effects. There are lovely holistic vets too http://www.avhma.org to find one near you. Fabulous article, wonderful comments.

  2. liz
    friendswood texas
    Reply

    In 2011, I awoke to severe back pain. I could barely walk. The dr. decided I needed back surgery. By the time the surgery could be scheduled my blood pressure started rising and my left leg started swelling. I went ahead with the surgery thinking the other problems where from the back problems. 1 month later my legs where swelling so much I could not walk and fluid was leaking from them like sweat.

    My PCP sent me for heart tests since my blood pressure was at 190/120. No problem was found but I was put on lisinopril anyway. I insisted on being sent to a lymphodema clinic and that was a month of torture and great expense but it got the excess fluids eliminated for the most part. Then 5 months later I had a second back surgery to replace a portion of my spine. 2 years later I was still in so much pain every hour of the day I prayed to die over and over. My bp was over 200 and I was allowed to do any more physical therapy until it was lower in spite of being prescribed 2 more bp meds on top of the lisinopril which after falling several times I finally took myself off of since my drs. said it could’nt be from the pills.

    By this point I had seen a back specialist, a heart specialist,my arthritis specialist, a pain specialist and my family practice doctor that my family had been using for over 20 years and all pretty much gave up saying I just needed to lose weight. So I worked out as much as could crying and screaming in pain all the while.

    On August 28 2014, 3 years after the original diagnosis, I felt even more pain and went to the er to be told my left kidney had 5 large tumors that were blood filled an some had burst and I was bleeding internally. The surgeons saved the kidney but I was left with stage 4 kidney failure and after a lot pain and expense I am trying to salvage those parts of my life that are left. None of the doctors ever apologized or explained how this was ignored even though my 20 year physician had treated my son for inherited kidney problems and knew the family history on my side.

    I am still very angry and now I’m afraid with the changes to the health care laws, I’ll be left with no insurance to cover my now life saving drugs and treatment. I had always considered myself a tough broad. Now I scared and vulnerable. If would have seen a vet I would have been better off. In Texas , a lawsuit isn’t an option for me either. Thanks for letting get things off my chest.

  3. Cindy M. Black
    Seattle, WA
    Reply

    I think it’s pretty obvious that doctors DO NOT own up to medical mistakes. Of course it has to do with the bottom line; lawsuits can cost millions!

    I rarely get sick… not even once per year! But 2 years ago I got a bad cold which went into my chest. I had severe congestion and coughed hard for about 3 weeks. The main symptoms went away but some minor congestion in my lungs absolutely refused to resolve. Finally my doc referred me to a lung specialist, who found a “small spot” and decided to do a pulmonary endoscopy — a “very minor” outpatient procedure which she said might cause some “minor discomfort” right afterward but nothing more.

    WELL…! As I climbed down off the table after the procedure, I was hit with the worst pain I’ve ever experienced. My knees buckled! This pain continued unabated for at least 3 weeks, accompanied by massive chills and fever, night sweats, nausea… I was sick as a dog!!!! Over this period, the “lung specialist” kept changing the story. She gave me at least 4 conflicting “possible explanations” for all this, each time stressing that she had no idea why this should have occurred, and that there shouldn’t have been any pain, etc. I should’ve been admitted inpatient, but she never even suggested that. It was utterly freaky!

    After 3 hideous weeks on strong antibiotics and pain meds (which I’ve never taken before), the sx’s began to subside and I gradually improved. But never any real explanation, and no apology. I was absolutely fine when I climbed onto that table, and in a world of hurt when I climbed off. OF COURSE something happened during that endoscopy (which turned out “negative”), but they would never admit it. And of course I had to pay for the meds, the follow-ups, the CT scans and so forth. Even though it was their fault! Sheesh. Grrr.

  4. Laurie
    Reply

    Thank our legal system for this particular situation. Physicians are targets for lawsuits. What incentive do they have for being completely transparent?

  5. Rick
    Reply

    Doctors do not have the time to admit to medical mistakes they are to busy filling out prescription pads and bank deposits.

  6. CP
    MO
    Reply

    My daughter is a RN, and was working in WV. I won’t tell the year or at what hospital. She had been a RN for two years. She told me and her Dad that she was in charge of care of a very elderly man who had just had surgery. The man’s doctor came in to the room. He was going to take some blood out of the man’s carotid artery. The Doctor pushed air into the man’s artery, instead of taking blood out. My daughter was shocked. The Doctor said, “opps, well he was dying anyway”. She told us he gave her a look, “don’t ever mention this to anyone. We were shocked when she told us about it.

    I visited my Doctor a few weeks ago. I told him that someone in my family had just been diagnosed with Elhers-Danlos, and I had some of the symptoms, and I wanted to be tested for it. He said, “What use is it to be tested. There is no treatment for it, and you’ll just have to live with it.” Well, I will see a podiatrist next week. I’ll ask him to order the test. If I have it, I want it to be documented, for my future.

  7. Lois M.
    Florida
    Reply

    I had a quad heart bypass in another county from where I live and went to my primary care physician after I was discharged from the hospital. He was supposed to refer me to specialists concerning my health; cardiologist; INR specialist to monitor my blood; etc. Many Drs. were to be involved. When my daughter and my husband took me to see him; he said he was discharging me as his patient, as I had too many medical problems and he could not coordinate appointments with all those specialists. All he had to do was make referrals to those other Drs. He wouldn’t even write refills for my prescriptions for my heart medications; he said I was no longer his patient??? I could not believe it. I had to find another primary care physician that was covered under my insurance and have to go out of town to see her, because there were no local Drs. except “him” that were covered under my insurance plan. I was without a Dr. for 3 weeks and could not get my scripts filled until I went to the new Dr.

  8. Laura
    Reply

    This comes as no surprise to my partner and I. My partner’s Stage 3 (now 4 and terminal) cancer was discovered VERY late, probably fatally late, because a series of doctors not only neglected to advise my partner he should have a stool test, but then proceeded to misdiagnose his profuse rectal bleeding and severe pain during and after digital exams as bleeding internal haemorrhoids. This went on for years. We’re too exhausted to make complaints against these doctors, although I believe one of them has lost his license anyway for treating female patients when he was under direction not to do so.

  9. Larry M
    Raleigh, NC
    Reply

    I understand the problem well. My late wife of 35 years died due to misdiagnosis of a new primary gall bladder cancer as recurrence of a recently, successfully-treated colon cancer, in spite of the fact that PET scan and MRI showed the new cancer wasn’t in the liver.

    Misdiagnosis continued after several other anomalous events (unexpected extreme pain, failure to respond to usually-effective chemotherapy, bone metastasis) all completely uncharacteristic of colon cancer. The correct diagnosis was ultimately made six months later (too late) by an emergency room physician and confirmed by pathology report after a laparoscopic cholecystectomy. She lasted about eight weeks longer.

    The oncologists have avoided even speaking to me and it’s been eleven years. I bear them little ill will. The first one wasn’t that sharp and the second one was influenced by the first one’s report and failed to think beyond it. Introduction of computer diagnoses (perhaps like IBM’s “Watson”) will provide a list of alternate diagnoses for physicians to consider, reducing one-track thinking.

  10. Lisa
    Florida
    Reply

    My sister went to a top hospital in Boston where it was detected she had a (very rare) thymoma. The biopsy showed it was malignant and NCI guidelines call for follow-up treatment. However, her surgeon did NOT tell her it was malignant and sent her back to her PCP with no comment – nor did her 2 other doctors treating her tell her. Two years later, she felt poorly, lost weight and another tumor – much larger – was found. After getting all the medical records from Boston, we discovered the problem – and why a second tumor appeared. We found the best specialist in US for this problem in Indiana and went there, where it was determined she had Stage IVA cancer now.

    She had chemo, then radiation, then a very difficult major thoracic surgery that saved her. They order CT scans every 3 months and 3 years later, two very tiny tumors appeared and she had aggressive proton beam therapy that eradicated the problem. She is now at Stage IVB cancer and having CT scans every 6 months. ALL of this could have been stopped by being treated in 2005 when the original tumor was found – IF she had been told she had cancer. We would have immediately sought the best care possible for the condition. Once all this was uncovered, we wanted to have a meeting with the doctors at the hospital to ask WHY this happened and perhaps get at least an apology. They would not meet with us and lawyered up. Malpractice laws in MA found that winning a case like this was not likely. So now we personally triple-check everything a doctor tells us and we get all the medical reports ourselves to look them over and see if the doctors neglected to tell us anything.

  11. Jim B
    TN
    Reply

    As a primary care physician, health care researcher, and author of The End of Healing (a novel about a young physician’s journey into the underworld of the healthcare industry), I find the study findings quoted consistent with what other studies have shown and the stories I hear from patients. Primary care doctors are so accustomed to care breakdowns—they are the norm and the daily expected outcome of broken healthcare infrastructure designed for generating profit rather than health—that it seems impossible to report them all or to take responsibility for them.

    The providers feel completely out of control. This is especially true in primary care where over 50% of providers report serious burn out. Their burn out is caused by their toxic work environment and outmoded systems that make continuity and high quality care nearly impossible. This is the real world The End of Healing reveals, and patients and providers suffer needlessly as a result. We must first understand that world if we hope to change it for the better.

  12. Philip
    Mineola NY
    Reply

    It is my experience that doctors NEVER admit to making a mistake for fear of being sued for malpractice. My best example-in December 2000 I began having the following symptoms: chills, night sweats, fatigue,weakness, stomach pain, weight loss,etc. I saw an internist who sent me to a gastroenterologist who did a colonoscopy which was normal.

    He did not even see any polyps. He then implied that my symptoms were psychosomatic and sent me to a psychotherapist and a cardiologist-thank God the cardiologist ordered tests that showed I had endocarditis, I was started on antibiotics but it was too late to save my aortic heart valve which had to be replaced with a mechanical valve in May 2001 which required open heart surgery. Of course, I was never even contacted again by the internist or the gastroenterologist who had both said my symptoms were “all in my head”!

  13. Debi V.
    Burlington, NC
    Reply

    I had a doctor make a mistake when doing my sacroiliac surgery and he admitted it to me in recovery, but then when I went back to get my records for my other doctor, the records and x-rays that belonged to the other doctor and my family doctor had magically disappeared…

    To this day, 25 years later, they still haven’t found them… he is no longer with the practice after other complaints, but he made head of orthopaedics before he had left……. what a waste of good doctors to make room for this idiot…..

  14. Fran
    NC
    Reply

    If you add all the mistakes doctors make through omission or carelessness to the mistakes they make by applying, in all innocence, what they were taught in medical school, I would say it is time for the medical field to explore a totally different approach to health care.

  15. Cindy
    Reply

    This is experience that, to my amazement, involved a surgeon apologizing. I accompanied my senior friend to the hospital when she fell. Her hip was broken. She had surgery to repair it late in the day. She suffered from excruciating pain all night but the nurses were not authorized to increase her medication.

    The next morning, the surgeon came in and saw the notes the nurses had made. He sincerely apologized to my friend. He said he did not see how much pain medication she used regularly for years to endure severe spinal stenosis. If he had read that in her records he would known that he prescribed for post surgery pain barely more than her normal daily dose of pain medications. He immediately gave her enough to make her comfortable. ~ Cindy

  16. Emily P
    NC
    Reply

    Excellent article. I was rating this and accidentally gave a 1 star and tried to go back and give a 5 star, but it wouldn’t let me. Please alter this if possible. I want you to have a 5! My comment below. Feel free to edit .
    ——————————————————————————————————————————-
    I bought your book to help deal with a medical error for a family member. I’ve also been to national rallies, conferences, congressional aide meetings and done a few presentations. I agree with every statement you’ve made. We have a huge problem. Kudos to medical writers& providers alerting the public to dangers. “Deny&defend” & “code of silence” behavior is too often the norm and retribution occurs for those providers who dare speak honestly. Dr. Lars Aaning , Dr. Hooman Norchashm, and Dr. Makary are all doctors I admire. Like you all, they let the light shine on the problems.

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