Medical culture encourages doctors to avoid admitting mistakes

Medical culture encourages doctors to avoid admitting mistakes

If you become the victim of a medical error, should you trust your doctor to be forthright about his or her role in the mistake? That could be a bad idea. An alarming new study says that most doctors would try to obscure their role in the mistake, and most wouldn’t even apologize.

The study, conducted by a national team of researchers, posed two hypothetical scenarios involving medical error to more than 300 primary care physicians and asked how they would react. The first scenario involved a delayed diagnosis of breast cancer; the second involved a delayed response to a patient’s symptoms due to a breakdown in the coordination of the patient’s care. Most (more than 70 percent) of the physicians surveyed said they would provide “only a limited or no apology, limited or no explanation, and limited or no information about the cause.” The report was published last fall in the journal BMJ Quality and Safety.

The researchers noted that the strongest predictors of disclosure were “perceived personal responsibility, perceived seriousness of the event and perceived value of patient-centered communication.” In other words, doctors decide whether a mistake is a big enough deal to reveal to their injured patients.

In reality, the factor that most influences doctors to hide or disclose medical errors should be clear to anyone who has spent much time in the profession: The culture of medicine frowns on admitting mistakes, usually on the pretense of fear of malpractice lawsuits.

But what’s really at risk are doctors’ egos and the preservation of a system that lets physicians avoid accountability by ignoring problems or shifting blame to “the system” or any culprit other than themselves.

The lengths to which some doctors will go to shirk their responsibility to be upfront about medical errors are astounding. I consulted with one patient who experienced this kind of blame-shifting firsthand.

After what was supposed to be a routine spinal fusion procedure, Natalie (not her real name) awoke in extreme pain. The neurosurgeon put her on steroids for pain relief. Two days later, a different neurosurgeon discovered in post-operative imaging that the surgeon who performed the procedure had put a screw inside Natalie’s spinal canal — far from where it should have been and a tiny distance from damaging her spinal cord.

The original surgeon’s explanation? “The screw migrated.” Buffalo and geese migrate. Medical screws placed properly and carefully into bone do not.

As patients, we are conditioned to assume that our doctors know best and always have our best interests in mind. When they refuse to own their mistakes, they betray that trust and foster an environment in which patient safety takes a backseat to doctors’ reputations.

The end result is a medical culture in which errors cause 250,000 deaths per year in the United States alone, making it the third leading cause of death, behind heart disease and cancer, according to research published last year by Dr. Marty Makary, a Johns Hopkins surgeon and outspoken patient safety advocate, and research fellow Michael Daniel.

What is a patient to do in this environment? The first thing is to be aware of your own predisposition to take everything your doctor says at face value. Listen closely and you may hear cause for more intense questioning.

You will likely never hear the terms negligence, error, mistake, or injury in a hospital. Instead, these harsh but truthful words and phrases are replaced with softer ones like accident, adverse event, or unfortunate outcome. If you hear any of these euphemisms, ask more questions or seek another opinion from a different doctor, preferably at a different facility.

Most doctors would never tell a flagrant lie. But in my experience as a neurosurgeon and as an attorney, too many of them resort to half-truths and glaring omissions when it comes to errors. Beware of passive language like “the patient experienced bleeding” rather than “I made a bad cut”; attributing an error to random chance or a nameless, faceless system; or trivialization of the consequences of the error by claiming something was “a blessing in disguise.”

When a serious preventable medical error occurs, the physician who made it always has the option to do the right thing and fully disclose what happened. He or she can make an honest apology, which must include accepting responsibility for the error. He or she can also explain what options are available for compensation. Anything less is a pseudo-apology at best and a cover-up at worst.

Lawrence Schlachter, MD, is a board-certified physician, a medical malpractice attorney, and the author of “Malpractice: A Neurosurgeon Reveals How Our Health-Care System Puts Patients at Risk” (Skyhorse Publishing, January 2017).

9 Responses

  1. A surgeon left me with permanent nerve damage because he ignored my endless listing of red flag symptoms of acute nerve compression. He dismissed everything I said and kept telling me to ‘smile so you’ll look pretty.’ Later, he told me that since I could still go shopping, all the disability I was left with was negligible. I’ve received no help in learning to live with the mess I was handed. Most doctors I’ve turned to for help were dismissive and outright contemptuous.

    I looked into filing a malpractice lawsuit but was told by a lawyer that it would be pointless. The surgeon is a respected, powerful, highly paid, rich white male. I’m nothing but a past my prime (40 something), unattractive, female high school teacher. If I tried pushing it, he could retaliate, even to the extent of going after my teaching license so I’d be fired and my career would be over. Everyone would believe him and everything I say would be dismissed as hysterical exaggerations by just another worthless woman.

  2. I’d file this one under “well, duh.” It’s like trumpeting a study that demonstrates that water is wet. And I’ve had several physicians flat out lie to me, one so egregiously –& for no reason– that it literally left me speechless. I’m still shaking my head about it, 2 years later….he lied about what his specialty was.

    Several years ago, I was abused by a NP at a pain clinic & filed a formal complaint with the state nursing board. The result: I got fired as a patient. At LEAST 4 other patients filed formal complaints against the same nurse for the same thing; all got fired as patients, too. So I never expect a doctor to ‘have my back’ or admit a mistake or have my best interests at heart in any kind of iffy situation. They should add CYA to the MD label.

  3. Our physicians MUST earn CONFIDENCE from their patients. Therefore it is not in the best interest of the physician to “admit” a mistake. I would much rather be told truth. If I as a 37 year businessman “make a mistake”, I must pay the penalty! Physicians, healthcare nurses, techs, and healthcare facilities do not .admit mistakes A physician is the ONLY. professional allowed to call their businesses a “practice”.

  4. Sorry for the lengthy narrative. I have a personal passion to help people/patients FORCED to “taper” opioid medication. What has happened and appears will continue to happen, pain management neglect and patient ABANDONEMENT must stop.

  5. I don’t want needles near my spine, that medicines makes my extremities go numb, I am not driving into the city everyday for one methadone pill, you are a mother killer, you are a coward, I am not explaining anything to you anymore, why saw on my heart if you do not treat my severe pain which ruined my heart …are just some of the things I have been forced to say around an obviously incompetent “Doctor of Medicine”.

  6. In 2009, after being a patient at a pain management specialist for 14 years, pill counted, random urine screening, NEVER “failing” protocol for sustained therapy with opiate medication I was forced to seek a different way to manage severe,, constant pain from failed back surgeries. When accepted for treatment at a spine pain management “specialist” the first thing he “prescribed” was an MRI ….with contrast. With contrast meant that the MRI procedure was to include having a chemical compound injected directly into my blood stream so that the MRI would better indicate, show, if and where I had a spine issue. This was no doubt “ordered” most likely by the specialist to Cover His A$$ to continue opiate medication prescribing as I had had for the previous 14 years. Possibly it had already been mandated to the physician, specialist to order the MRI “with contrast” knowing what was to come with the likes of the CDC “guideline”,. I don’t know. Regardless of why the “with contrast” was ordered, it turned out that I had a near death allergic reaction to the commonly used dye, chemical compound. Anaphylactic shock was induced by this chemical compound use as a tool by physicians to gain further insight, a look if you will as to the issue causing pain in my case. Was my claim of unending, severe pain justifiable enough to continue opioid therapy was what the scan should reveal. After the crash cart and about 5 other technicians, nurses arrived as soon as it was realized that I was in danger of Death, I was immediately given Benadryl along with other medications to counter the shock my body had went into. I left the imaging center about 2 hours later, not realizing that PERMANENT damage had been done by this “contrast dye”. I went back to work, the same day, but I noticed for the next several weeks I was extremely tired and could NOT function at any where near the level I could BEFORE the dye was injected. A visit to my General MD got me a visit to a kidney specialist. The nephrologist after a few tests stated that I had lost about 50 percent of my kidney function….immediately upon the “dye” being injected into my body. didm the imaging center t the hospital “apologize” in any way or take responsibility? NO. They were just doing what was ordered….to be done. Did my pain management specialist “apologize” for my 50 percent kidney loss? NO. He was empathetic but, only )NE in every 250,00 patients or so had this type reaction. In other words, it wasn’t “his” fault. Could I get legal representation for what I happened which is surely to end my life earlier, or at least force me to go on dialysis very shortly? NO. If the procedure did not IMMEDIATELY force me to go on dialysis, then I had ZERO legal recourse. IF I have to go on dialysis or other procedure to keep me alive….later in life, the statute of limitations prevented me from ANY legal recourse in the future. Do I “blame” the hospital imaging center? NO. Do I blame the physician that ordered an MRI “with contrast”? NO. So WHO is at fault? NO One? ME? Anyone? Did I get an “apology from any health care professional? NO. Should I have? Empathy from the hospital? NO. Empathy and a half-ass I sorry from the physician. Yeah, but that’s it. So now I have regular kidney function tests and I am just waiting to be forced to go on dialysis. WHY? Because the physician had to “justify” continued prescribing of an opiate medication that I had been documented as using which was working fine without ANY indication that the medication should be discontinued. The “gray area” of medicine that no doubt will cause health issues to the degree of life….itself. This was 9 years ago, so far so good but………..

    • So sad. We can’t just throw money at liability, we must throw responsibility at liability also.

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