Thinking about Medical Errors and the Role of the Physician

It would be challenging and difficult for a physician to begin a conversation concerning medical error(s) with his or her patient since such a conversation will undoubtedly bring concern and perhaps alarm to the patient and their family. Especially in circumstances where the patient and family is already nervous and anxious, news of a medical error (no matter how small) may become very alarming, making it even more difficult to approach the topic of a medical error. In exchange for attempting to build an open and trustworthy dialogue with the patient, the physician could be sacrificing the trust a patient has in the physician. From a physician’s standpoint, a medical mistake does more than question his abilities and skill, it has the potential to damage the doctor-patient relationship. However, acknowledgment of such known errors should be made by physicians on behalf of their patients’ best interest.

Despite all this, perhaps we could put ourselves into the patients’ shoes and ask ourselves if we would want to know. While it may or may not be beneficial to the physician as he may lose a patient’s confidence and trust and risk lawsuits, do patients have a right to know the care and quality of care they have received? Honesty and acknowledgment of mistakes when they occur Furthermore, should patients then also have a right to refuse further care from their physician?

This is the same thought as what other people have said but if there are certain ‘minor errors’ that can forgo mentioning, where should physicians draw the line to define what is minor and major? Are they able to do that when sometimes physicians can’t see into the future and then encounter the unforeseen consequences of their mistakes? If not every minute mistake, how much?

When there is a perpetual fear of taking responsibility for errors, it begins to create a barrier to open communication. That mindset could spread within the hospital staff, nurses, between doctors, and of course patients as well. Fear of admitting mistakes could become increasingly costly. For example, checklists have been developed recently so that staff can cross check each other, including the doctor, without being afraid of calling out a senior staff member. This affords everyone a voice to express doubts and hopefully, avoid devastating errors.

Finally I think in some cases (i.e. involving a complicated procedure), it may be important to speak to patients before the procedure about the possible risks involved and also what is being done in to prevent them.

 

Respecting Diversity : Should Doctors Define Boundaries

As a physician, I think it is important to know where you stand on issues and remain true to your own beliefs. But it is also important to realize the limits of when your own strong beliefs could become a barrier to treating the patient as a whole.  It is critical to the practice of medicine as an art, as Ashley mentioned, to balance both the skills and knowledge a doctor has and his or her ability to put into perspective the circumstances surrounding a patient’s medical decisions. Otherwise, doctors become another cog in the machine, who only knows how to fix what is on the surface and dole out medicine as a standard recipe. In some cases, this can be detrimental to the diagnosis because the doctor may miss important aspects which contribute to the presenting medical complaint.

When science is applied without considering all the other aspects of the person, it’s possible to overlook the best way to approach treatment for the patient. As physicians, there is a responsibility to interpret and explain medical conditions/treatments to patients in a way they can understand and hopefully, find acceptable without compromising their own beliefs. Additionally, if the doctor solely focuses on the science aspects of a patient’s medical problem and disregards all else as inferior, a patient might become increasingly hesitant to be upfront and honest with the physician and thus, less likely to be responsive to the physician’s suggestions. As Alexis suggested, a doctor has a duty to put into use his or her skills while being sensitive and respectful of the cultural framework in which the patient has been living their whole lives. Her approach is ideal because it acknowledges the mother’s strong beliefs while simultaneously advocating what the physician feels would be best for the health of the mother and child. This way, the physician is expressing his/her concerns without diminishing the dignity of the patient’s cultural standing. It is interesting to consider the reversed situation of when a doctor is serving in a foreign country. For example, what should the physician do in a village where a traditional healer has been the source of medical remedies for most of the village’s existence? Is it entirely ‘right’ for the doctor to go into the village with an attitude/expectation to disregard, override, or uproot those deeply rooted beliefs on the premise that science trumps all? How effective is it for a doctor to go into practice without attempting to hear a patient’s beliefs, cultural concerns, etc.?

I don’t think tolerance means doctors have to accept everything but it does mean being respectful (and sensitive) to them by being open to at least listen and consider the patients’ views. Just as the doctor has strong moral beliefs that compels him/her to act, the doctor must realize the patient’s beliefs may just be as strong. The doctor and the patient together should then try to evaluate the best course of action, whilst acknowledging both the doctor’s and patient’s views.

A patient is not entering a treatment option aware and comfortable with his/her decision, then there might not be enough communication. The years of medical skill and knowledge a doctor has will put greater weight on a physician’s persuasion to take what he/she thinks is the best course of action, but does that knowledge exclude the physician’s duty to attempt to understand the patient as a person?

Regarding whether a physician can choose whether or not to provide all the information/options available to his/her patient, I do not find it possible to rectify this decision based on the physician’s own personal beliefs. I feel that it is fair (in non-life threatening situations) for the physician to choose not to perform some procedures like abortion or physician-assisted suicide based on their own moral standards because when the physician is pressured to do so, the procedure is not performed in the ‘best hands’ whereas another physician comfortable with the procedure would be in a better position to do so. But when a physician knows about other options and chooses not to reveal those options to the patient, he/she goes against the doctor’s responsibility to communicate with his/her patients.  is essentially taking control, limiting the patient’s knowledge and deciding for the patient a course of treatment that the doctor chooses but