Article

Coping with medical mistakes and errors in judgment

Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA.
Annals of Emergency Medicine (Impact Factor: 4.33). 04/2002; 39(3):287-92. DOI: 10.1067/mem.2002.121995
Source: PubMed

ABSTRACT Attention has recently been focused on medical errors as a cause of morbidity and mortality in clinical practice. Although much has been written regarding the cognitive aspects of decision making and the importance of systems management as an approach to medical error reduction, little consideration has been given to the emotional impact of errors on the practitioner. Evidence exists that errors are common in clinical practice and that physicians often deal with them in dysfunctional ways. However, there is no general acknowledgment within the profession of the inevitability of medical errors or of the need for practitioners to be trained in their management. This article focuses on the affective aspects of physician errors and presents a strategy for coping with them.

Download full-text

Full-text

Available from: Louise Andrew, Apr 06, 2014
1 Follower
 · 
133 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Official policy-making bodies and experts in medical error have called for a shift in perspective to a blame-free culture within medicine, predicated on the basis that errors are largely attributable to systems rather than individuals. However, little is known about how the lived experience of blame in medical care relates to prospects for such a shift. In this essay we explore the benefits and costs of blame in medical culture. Our observations are informed by our clinical experience and supported by interview data from a study in which 163 American physicians were interviewed about caring for a total of 66 dying patients in two institutions. We observe three ways in which blame is invoked: (1) self-blame, (2) blame of impersonal forces or the "system," and (3) blame of others. Physicians articulate several important functions of blame: as a stimulus for learning and improvement; as a way to empathically allow physicians to forgive mistakes when others accept responsibility using self-blame; and as a way to achieve control over clinical outcomes. We argue that, since error is viewed as a personal failing and tends to evoke substantial self-blame, physicians do not tend to think of errors in a systems context. Given that physicians' ideology of self-blame is ingrained, accompanied by benefits, and limits a systems perspective on error, it may subvert attempts to establish a blame-free culture.
    Social Science [?] Medicine 09/2009; 69(9):1287-90. DOI:10.1016/j.socscimed.2009.08.033 · 2.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Medical errors became a common topic of conversation with the release of the Institute of Medicine's "To Err Is Human" in November of 1999. This release reported that as many as 98,000 people die each year from inpatient medical errors. Putting this into perspective, deaths from medical errors surpassed deaths from breast cancer, motor vehicle accidents, and AIDS. Furthermore, medication errors account for more deaths annually than workplace injuries. This article addresses communication of adverse outcomes to patients (disclosure) through transparency and apology.
    Obstetrics and Gynecology Clinics of North America 04/2008; 35(1):53-62, viii. DOI:10.1016/j.ogc.2007.12.007 · 1.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To assess the strength of the evidence for disclosing errors to patients, focusing on patients' and physicians' attitudes toward disclosure and dis-closure's effect on malpractice claims, and to present practical suggestions for disclosing medical errors. • Methods: Review of the literature. • Results: A gap exists between patients' preferences for disclosure and current clinical practice. Patients have consistently expressed a desire to be told about harmful medical errors, and want to know why the error happened, how recurrences will be prevented, and to receive an apology. However, current data sug-gests that as few as 30% of harmful errors are dis-closed to patients. Physicians support the general principle of disclosure, but hesitate to share the infor-mation patients want about errors. Physicians identify fear of liability as one important barrier to error disclo-sure and experience significant emotional distress after a harmful medical error. Limited data suggests that some institutions have adopted policies of more open disclosure without adverse malpractice conse-quences. The current disclosure literature contains important but unanswered questions, such as how patients' preferences for disclosure vary along cultural and other dimensions, and whether recommended disclosure strategies improve patient trust and the like-lihood of lawsuits. In the absence of definitive evidence about the outcomes of disclosure, practical sugges-tions for talking with patients about errors can be derived from the literature on doctor-patient communi-cation, breaking bad news, and conflict resolution. • Conclusion: Patients want to be told about harmful errors in their care, but at present such disclosure is uncommon. Closing gaps in the existing disclosure lit-erature could help clinicians communicate more effec-tively with patients following harmful medical errors.