What Should I Do If I Witness a Medical Error?

Megan Fix, MD

Disclosures

November 14, 2008

Question
If I see an attending or resident commit a medical error, what should I do? Should I tell the patient or report the problem to someone else?

Response from Megan Fix, MD
Attending Physician, Maine Medical Center, Portland, Maine

Medical errors are prevalent, often times preventable, and are the responsibility of each and every member of the healthcare team. Even as a medical student, you have a duty to protect your patients and keep them safe. Witnessing a physician make an error puts you in an awkward position, but the more you feel empowered to protect your patient, the easier it will be to speak up.

As reported in the landmark paper, "To Err is Human," between 44,000 and 98,000 deaths per year are due to medical errors.[1] Many of these errors are preventable. Do not underestimate your role as part of your patient's safety net. You can help prevent these errors and also help disclose them when they happen.

In a recent article by 3 medical students, 1 student explains how she helped intercept a potential error when a patient was improperly prepped for surgery.[2] She spoke up, not once but twice, so that the patient could be re-prepped. Even within the medical hierarchy, your communication is important. In that moment, she put the patient first and helped avoid a potentially harmful error.

When medical errors occur, it is our duty to disclose them. Truthful disclosure is good for patients. Recent evidence shows us that most patients actually prefer to know about medical errors that have happened to them. Furthermore, surveyed patients said they would be less likely to sue if they were informed of the error by the attending physician.[3]

So now that you feel empowered to prevent and help disclose medical errors, how do you do so? The easiest way is to be direct and honest in a respectful manner. You are never wrong if you put the patient first. Remember that you are a part of a team.

Get the facts in a nonjudgmental way. Was this a medical error due to equipment or dispensing of medication? Medical students are still in the role of the learner. It never hurts to say something like, "this may be a ridiculous question but..." or "I may be mistaken, but..." This is a respectful way to ask what is right for the patient and oftentimes, once the error is identified, both you and the attending physician can then respond and inform the patient together.

Be a team member. You may feel compelled to "tell" on the attending physician or resident who committed the error, but this will not only undermine your relationship with the patient, it will also create distrust and lack of confidence within the whole medical team. As part of the team, your goal is to work with the attending physician to disclose to the patient or to make the error right. One way is to respect the authority of the attending physician by asking for their assistance. This can help deflect possible defensiveness that may arise. For example, you might say, "I spoke with Mrs. Jones and she is very concerned about X. I would like your help discussing it with her." If that does not work, then approach your resident. Again, put the patient first as in, "I was concerned about our patient when I saw Y. I'd like to talk to the attending physician, will you join me?"

Remember that the attending physician has the ultimate responsibility. If an error is made, it is his or her job to disclose the error to the patient. You may help protect your patient by asking the attending physician to disclose, but it is not your job to do it alone. If you are having difficulty, ask for a second opinion from a trusted faculty member or an ethics committee member.

I encourage you to read a series of medical student essays on this topic from JAMA.[4] In 1 excellent essay, Courtney J. Wusthoff beautifully summarizes the role of the medical student in an error situation[5]:

In determining a course of action, the medical student must consider duties to the patient, physician, and him- or herself. It is inappropriate for the student to unilaterally disclose the error, yet the student must not allow the patient to be deceived.

Medical errors will happen, and when they do, we must maintain our duty to the patient. Even though we all make mistakes, most of us want to do the right thing. In these situations, the right thing is to put your patient first and act in an ethical and respectful way.

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