The People's Perspective on Medicine

Show 1007: Coming Clean on Medical Mistakes

Do hospitals and health care providers admit to medical mistakes? They may be afraid of litigation, but transparency may reduce the risk of lawsuits.
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Coming Clean on Medical Mistakes

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The Institute of Medicine released an important report on diagnostic error this week, Improving Diagnosis in Medicine. The issue of medical mistakes is a serious problem that has not disappeared.

Admitting Medical Mistakes:

If a doctor or a hospital makes a mistake, will it be admitted? Research shows that many health care providers are not inclined to come forward on admitting medical mistakes. There is fear that doing so will result in litigation or other recriminations. Is that fear justified by scientific research?

Failure to make the correct diagnosis is a serious problem that is rarely acknowledged. One eminent physician tells how those who cared for him didn’t admit their diagnostic failure, and how their medical mistakes led to his need for a heart transplant. If this kind of medical disaster can happen to a brilliant cancer researcher it can happen to anyone.

Seven Pillars of Transparency:

Despite the fear, some health care institutions have found that transparency with respect to errors actually reduces lawsuits and generates good will. Learn about the Seven Pillars approach to disclosure and remediation utilized successfully at the University of Illinois. Should it be adopted elsewhere?

This Week’s Guests:

Lisa Iezzoni, MD, MSc, is professor of medicine at Harvard Medical School. She is director of the Mongan Institute for Health Policy at Massachusetts General Hospital. The article we discussed was published in Health Affairs (February, 2012).

Tim McDonald, MD, JD, is the inaugural Service Chief for Anesthesiology at Sidra Medical and Research Center in Qatar, where he is also Medical Director of Quality and Safety. He also holds the position of Chair of Anesthesiology at Weill Cornell Medical College in Qatar.

Prior to joining Sidra, Dr. McDonald was Chief Safety and Risk Officer for Health Affairs at the University of Illinois. He was also Professor of Anesthesiology and Pediatrics at the University of Illinois College of Medicine at Chicago and Adjunct Professor or Law at Loyola University School of Law. The Seven Pillars program was instituted at the University of Illinois. The photo is of Dr. McDonald.

Neil Spector, MD, is the Sandra P. Coates chair in breast cancer research and an associate professor of medicine as well as pharmacology and cancer biology at Duke University Medical Center. His book is Gone in a Heartbeat: A Physician’s Search for True Healing.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Oftentimes healthcare practitioners are unaware they made diagnostic errors and patients unfortunately don’t know any better. I also think we grossly overestimate the ability of doctors to diagnose and treat our ailments. Doctors are only human. Until we develop more effective diagnostic apps or screening tools, I don’t think we can expect much more. Self advocacy can help – I recommend patients learn how to interpret test results – not to self-diagnose, but to ensure your results make sense with your diagnosis (and that your name, age, gender, etc were input accurately on lab results ). Request copies of your results and get a 2nd opinion if you’re not comfortable with the diagnosis/treatment.

I had a failed hysterectomy that resulted in my intestines falling out of my body 3 months after the hysterectomy was done. My hysterectomy was aided by the Divinichi robot. In the emergency room, the on call OB/GYN doctor, from the practice that my doctor was in, said that the “cuff” had opened like a Ziplock bag. No tearing (which would explain why I hadn’t had any signs like bleeding). It just neatly opened up and let my intestines out. Upon doing a little research I learned that the doctor operates the robot through a screen and the proportions and depths are something the doctor has to adjust to. It appeared that when he stitched me up he did not go deep enough and get enough tissue. Not only did he not admit to any wrong doing he actually tried to blame it on my husband telling me that “he had had other patients whose husbands would not wait for intimacy and caused their wives to tear.” I was so angry (this was said in front of his nurses who were in the room)! I told him in no uncertain terms that this was absolutely not the case and that “all” of the doctors orders were followed in my case. We filed a complaint. Our complaint was denied but mysteriously my hospital bills were paid (but not by my insurance company or us!) The doctor’s office actually sent me a bill for their services to which I sent a very specific letter back saying that there would not be a dime coming there way in light of the life threatening error my doctor had made. That bill went away too. But I am left with a very disfigured stomach because in the emergency room my internal parts were not put back the way they were before they fell out of my body. I have a permanent, large lump a little larger than a golf ball. Needless to say I did not want to go back into surgery to try to fix that so I just live with it.
I certainly wish my doctor had been able to admit he made a mistake instead of trying to blame it on my husband who was, like me, very horrified over this event.

I cannot strongly enough support Dr. Tim McDonald’s “7 Pillars of Transparency ” as a way for medical caregivers to deal with serious mistakes. A few years ago my wife died as a result of a botched minimally invasive procedure to repair a mitral heart valve. Not one of her caregivers would speak to me truthfully after she died, even though I made numerous attempts to have conversations with them. I had to initiate a very painful and prolonged legal action just to find out what happened to my wife. Throughout that process the suspicion grew that these particular doctors and nurses just plain didn’t give a damn. Whether people like my wife lived or died under their care met absolutely nothing to them. Although my lawsuit was successful, it left me with a long road I am still on in the effort to regain any kind of trust in the medical profession. This is an undeserved black mark on all the truly honest and caring medical caregivers that are out there.

One problem we’ve run into is that under the “team” approach, where many chronic, morbid, crital care is the model in hospitals, the team is often headed up by or largely managed by more powerfully weighted personnel such as social workers, etc., who do not have the critical expertise of the physicians, surgeons or specialists who know the patient’s case more intimately. And as such, their decisions are often based on office or hospital politics, insurance — non-medical lines and supersede those directives of the medical side of the team. So, where the medical voice of the treatment team may have the patient’s best health care in mind, the non-medical side of the team has the final say which is not always in the best interest of the patient. In such cases this may lead to what appears to be a critical medical error. But the physician’s hands are tied and their mouths gagged.

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