Should Docs Rethink Saying 'I'm Sorry' After a Medical Error?

Leigh Page

Disclosures

July 17, 2019

Naunheim agrees that doctors have a heavy burden to carry that may be unrealistic. "Even though medical mistakes are inevitable, the standard for medical practice has evolved to the point where only perfection is acceptable," he says.

He even cites other problems with full disclosure. "Sometimes telling patients everything that occurred can confuse rather than enlighten them," Naunheim says. "If it's a complicated issue and they have limited education, they may misunderstand what you are trying to tell them."

However, unlike Cotton, Naunheim believes doctors should still tell patients everything, despite all the problems with doing so. "That is the standard now," he says. "You don't withhold information from patients."

Naunheim's conflicting views about revealing errors are not unusual. Although a sizeable proportion of physicians don't reveal their own errors, many of them still believe they should be doing so. This comes out in the professional standards they approved.

The Code of Medical Ethics of the American Medical Association (AMA), approved by members and nonmembers making up the AMA House of Delegates, states that when a patient suffers due to a medical error, "the physician is ethically required to inform the patient of all the facts necessary to ensure... [the patient can] make informed decisions regarding future medical care."[8]

Naunheim believes that disclosure is the right thing to do, and when delivered in an apology, it can help the doctor "gain absolution" from the patient. "When you apologize, and the patient says, 'I am not happy with what happened, but I still trust you as a surgeon,' this could take some worries off your shoulders," he says.

Proponents of apologies see this process as almost a spiritual awakening. "The very act of approaching patients with the truth is so profound that it has almost invariably strengthened the patient-physician relationship, not the reverse," according to Richard C. Boothman, a former malpractice attorney whose program at the University of Michigan Medical Center (UMMC) advocates apologies.[9]

Physicians May Try to Bury Errors

Many doctors, however, are shy of having to apologize and stop well short of revealing the truth, according to Lawrence Schlachter, MD, a malpractice attorney in Roswell, Georgia. "In my experience as a neurosurgeon and as an attorney, too many [doctors] resort to half-truths and glaring omissions when it comes to errors," he wrote.[10]

Schlachter recalls an orthopedic surgeon defending an error and insisting to the patient that a medical screw had been placed in the right spot but "migrated." "Medical screws placed properly and carefully into bone do not [migrate]," Schlachter wrote.[10]

Sometimes doctors and hospitals keep errors entirely out of the medical record, according to Harald Lars Aanning, MD, a retired general surgeon in Yankton, South Dakota, who reads charts for malpractice cases.

In one case he reviewed, a 65-year-old woman died of sepsis after undergoing routine outpatient surgery. Aanning said the obstetrician-gynecologist who performed the surgery repeatedly expressed his sympathy to the family, saying, "I am so sorry!" South Dakota has a partial apology law covering such expressions.

The physician even kneeled and prayed with the family. He accompanied general surgeons who operated on the patient for sepsis each time they met with the family, even though he was not involved in those surgeries, Aanning noted.

The family became suspicious and hired Aanning to review the charts. Aanning could not find what caused the sepsis anywhere in the chart, but the principal discharge diagnosis code seemed to reveal it. It was K91.71, standing for "accidental puncture and laceration of a digestive system organ or structure during other procedure."

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