Doctors must honour Emma with culture of owning up to medical errors
WE ALL make mistakes but we don’t always take the opportunity to learn from them. We’d all be better people if we did.
For doctors, acknowledging their mistakes could mean the difference between a patient’s life or death. It could end health scandals and it is more urgent than ever with the sad passing of Emma Mhic Mhathúna.
Very often patients just want prompt apologies, some reasonable monetary compensation, and hope that other people won’t experience the same mistakes. Instead we’ve learned this summer that 221 women were not told about their smear test audits and a doctor told one cervical cancer victim to ‘watch the news’ if she wanted to know more about her misread scan.
In all of these cases, I don’t think the problem is that these individual doctors are particularly malicious. Sadly it’s because they operate inside a toxic and paternalistic culture – something that will be hard to fix and will need a strong and sustained will. It will also require that we have mandatory open disclosure, for individual doctors as well as for institutions.
Dr Gabriel Scally has said that we can’t continue keeping medical mistakes in the shadows and that leaving disclosure up to individual doctor’s personal and professional judgment isn’t good enough.
His report states: “The HSE’s open disclosure policy and HSE/SCA guidelines should be revised as a matter of urgency. The revised policies must reflect the primacy of the right of patients to have full knowledge about their healthcare as and when they so wish, and their right to be informed about any failings in that care process, however and whenever they may arise.”
In 2015, Leo Varadkar – the health minister at the time – announced that the government would require a legal requirement for open disclosure. But there was a climbdown two months later because of worries that it would require too much bureaucracy.
Then, in 2017, Simon Harris got approval from the Cabinet to introduce a form of voluntary open disclosure where medical professions would be protected from legal action for any information they provided.
But as Dr Scally says, this arbitrary system isn’t working for us.
Vicky Phelan has spoken out about her upset at not being told about the 2014 audit of her smear. “I told him that, in my case, it wasn’t just a systems failure. It was a communications failure when my doctor did not tell me about my audit result. If there is a breach of duty of care, there must be sanctions on the practitioner. This is the big issue for me.”
Some medical mistakes kill, but doctors make many more non-lethal mistakes. Studies confirm that patients – very understandably – want to know when a mistake has been made with their healthcare. But we have a culture of concealment in medicine, and while this is often attributed to fear of being sued, there’s also something else going on. Doctors don’t like to admit it when they make a mistake – it shows that the doctor doesn’t always know best.
That’s not good enough, especially since it’s been shown that filling patients in on errors in an upfront matter and apologising right away
A tiny number of injured patients win massive jackpots while the majority get nothing
can actually reduce the likelihood that a lawsuit will be brought.
In 2002, the University of Michigan health system moved from a ‘deny and defend’ policy to ‘apologise and learn when we’re wrong, explain and vigorously defend when we’re right and view court as a last resort’. It was fairly revolutionary and there were initial fears that this kind of transparency might exacerbate litigation.
However, the researchers found that there were actually fewer lawsuits and claims after the hospital began its disclosure with compensation programme.
And the hospital system’s liability costs for lawsuits, patient compensation and legal fees dropped. The statistics from August 2001-2007 reveal that average litigation costs have more than halved and significant savings have been invested for patient safety initiatives.
When you’re a doctor, you sometimes have to come to terms with making a mistake: giving a patient the wrong diagnosis or the wrong treatment, causing an injury or something worse.
When you break that paradigm of litigation and give patients the chance to understand the human element of the other side – of you, the doctor and what you are struggling with – you might be very surprised to find that people can be forgiving and understanding.
We deserve a health system where patients harmed by negligence get timely, reasonable compensation, but in a way that also protects doctors and encourages them to learn from their mistakes.
Our current system fails miserably and operates more like a Vegas casino. A tiny number of injured patients win massive jackpots while the majority get nothing.
We’ve been promised a bunch of basic fixes following the CervicalCheck scandal and Simon Harris has said he is willing to amend the Patient Safety Bill to provide for penalties against doctors who don’t tell patients when serious mistakes have been made. This needs to happen soon.
When a doctor is prepared to admit errors then they are also prepared to learn from them and that can only be good for the safety of patients. There’s something wrong when a lengthy lawsuit and media campaign is the only way for patients to get the answers they are looking for.