Doctor's Mistakes

By some quirk of fate I read two very interesting articles on the same topic yesterday. One was from Atul Gawande's book Complications( which btw is a very good read) and the other is from the BMJ.

Both talk about mistakes made by doctors. Read this article which is a doctors confession about a mistake he committed in diagnosing an elderly lady with a heart attack because he forgot to read the ECG.
Gawande chronicles the same sort of mistakes made by surgeons during their clinical practice.
My own take on mistakes made by doctors is rather simple and pragmatic. I know that mistakes will always be made by doctors. It would be impossible to find a doctor who has never committed a mistake, and very difficult to find one whose mistake hasn't led to increased patient suffering. Therefore we must try and
a. to reduce similar mistakes in your practice, among your peers and colleagues in the hospital
This is very often done by Autopsy meetings and as Gawande describes the Morbidity and Mortality Meeting, where the entire department, sometimes departments come to together to discuss cases of errors and changes that could be made to avoid similar mistakes in the past.
b. weigh the benefits of revealing the mistake to the patient versus the harm. This must sound very self-preservatory but let me give you an example of how revealing a mistake might cause greater harm than good. Consider an elderly patient in the NHS who has suffered from re-operation after abdominal surgery because the surgeon forgot a swab inside his abdomen. He was told of the error and was obviously incensed and distrusted all doctors. He now presents with Myocardial Infarction, heart attack in emergency and requires an Bypass surgery. Do you think he would give you consent if you were the same surgeon??
I am not in favour of withholding information from patients or falsifying documents, but I think in Medicine where a lot of decision making is based on intitution and experience, informing patients of doctor errors must be a cautious decision

Most commentaries on the subject argue that there is a loss of trust among patients when doctors cover up their errors and the rare one which is publicised makes sensational news. Somehow, I think despite the much publicised and quoted attitude change in patients, most patients who attend public hospitals trust doctors implicitly. I am not sure whether admitting to every doctor error helps in building trust.

The only advantage I can possibly envisage in humanising of the medical profession - understand ing that doctors are humans who commit errors because of the long hours they keep and the tremendous pressure and responsibilty they carry.

So, on the whole I think informing patients about doctors errors must ultimately rely on the physicians judgement. All errors must be discussed within the hospital in an educational manner, and changes in the system must be brought about to eliminate the chances of the error being repeated.