Health care professionals making honesty their policy

A long, long time ago, in an ER far away, I missed a crucial abnormality on an X-ray and the patient died as a result. Others missed it too, he might have died anyway, but there it is; I missed it and he died. In my head I have apologized to him and to his family for my error a million times.

The thing is, I never apologized to them in person. If I had, I might not still be carrying that mistake with me to this day like a never-healing sore hidden from everyone’s view but my own. I might not still wish the patient and I could have a do -ver of that fateful night. It might not still depress me when I think about it.

In those days, however, when physicians or hospital staff such as nurses made mistakes, we usually hunkered down and tried to hide what happened from our patients, from the lawyers and even from our peers. We thought the truth would spread with terrible results if exposed to the light of day. We figuratively, and sometimes literally, buried our errors out of embarrassment and fear of being sued if the truth be told. We did so in ignorance of the fact that errors buried beget future errors, and did not understand that many errors in health care are not so much the result of an individual’s moment of error, but rather our failure to build systems that protect patients from the inevitability of human error.

Well, we were wrong, and the times they are a-changin’. The door is opening on a new way to deal with errors in patient care, and slowly but surely the fresh, clean air of truth is coming to the relationship between patients and caregivers who unintentionally cause them harm. Telling the patient or patient’s family the truth about a harmful error in the patient’s care has become the new standard of care.

Why is it the health care industry is turning 180 degrees on this issue when the result may well be more lawsuits? Why would I now tell that patient’s family I missed a killer condition that caused his death when years ago I just slinked away in shame? It is because, as is often the case in the practice of medicine, the world has changed around us and we in health care are being forced to change in response.

First, we have less and less choice; the Joint Commission, which accredits many hospitals, and many states now require error disclosure by hospitals. That we have been led to this new way of doing things instead of leading the way to it has been unfortunate.

Beyond that, in the last 10 years, several facts have emerged about errors in health care that have made inescapable the truth that the truth must be told when we screw up. Perhaps most importantly, we have been pushed and pulled hard by our recognition of the volume of errors we have been making in health care; pushed by the scope of human suffering that has resulted, and pulled by our dawning recognition that the best way to prevent future errors is to look at previous errors openly and honestly, then build systems to prevent repetition.

We have also come to understand that health care providers cannot claim to serve in the best interests of patients if we don’t tell them the truth at all times. We are hard pressed to be the caring profession if we care more about our legal hides than our relationship with the patient after harming them with a medical error.

Third, while it is too soon to tell, it may just be that honesty with patients about our errors will result in fewer lawsuits, not more. Patients and families often sue because they know something went wrong and are rightfully hurt and angry when they cannot find the truth about what happened without going through a lawyer to get it. Truth be told, so would I.

On the other hand, a patient dealt with honestly upfront, told the truth about what happened, given an apology, told that they or their insurance will not be billed for the care necessary to fix the mistake (if that is possible), and told what the hospital or physician will do in order to avoid other patients being harmed by a similar mistake, might choose not to call a lawyer.

Even if honesty about errors does not result in fewer lawsuits, hospitals and the health care professions are coming to recognize that error disclosure is still the right approach. It is the right thing to do, and our response to the threat of lawsuits over errors should center on what it takes to make fewer errors and therefore get sued less often, not simply hide our errors and stonewall inquiries from patients and families about what went wrong.

Finally, health care professionals know that someday someone will make an error in their care, or in the care of a family member, and the shoe will be on the other foot. When that happens we will want what many of us are finally coming around to giving our patients – the truth about what happened, what will be done to prevent it from happening to someone else, an apology and assurance no one will be billed for the care necessary to fix the mistake. Anything less is a double standard for the caring professions and a festering sore on our consciences that otherwise will not heal.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.