Talking with Patients and Families about Medical Error: A Guide for Education and Practice

1. Medical Error through the Eyes of Clinicians, Patients, and Families

1 We begin with a story that illustrates dramatically the impact of medical error on patients and families. It involves a professional violinist who had been diagnosed with colon cancer. The following dialogue is taken from separate interviews with the patient, prior to his death, and with his wife and adult son. They describe a cascading series of disappointments that include faulty communication, complications from procedures, adverse events, and medical errors. In his first hospitalization , the patient underwent a partial colectomy, which was complicated by perforation of the ileum. He was discharged with undiagnosed pneumonia and then rehospitalized, at which time he fell while being transferred between hospital units. He was later hospitalized again to remove the colostomy. The procedure was unsuccessful, and he died four days later. The following are excerpts of the story as told by the patient, his wife, and son: P A T I E N T I think the head surgeon was lost. He approached me—I don’t want to say this badly—as if I were a piece of meat that he had just sewn up. If I would ask him a direct question, I would get, we might say, an indirect answer. For example my colostomy, I asked him, would I have to live with it or could I have another operation, and his answer would be, that’s up to me [the patient]. Well, I mean, I don’t know enough to make such a decision . . . In terms of compassion or understanding another person’s sensitivity, he did not make any effort to do that with me. ONE Medical Error through the Eyes of Clinicians, Patients, and Families 2 TALKING WITH PATIENTS AND FAMILIES ABOUT MEDICAL ERROR You have no idea how far a “sorry” will go . . . As to what I’m going to do about it, I don’t think there’s anything I can do. There is no recourse. I’m not aware that I, in the role of a patient, have any power at all. W I F E No one ever said they were sorry. You know, that’s what happens in medicine. They didn’t say that, they just never attended to that. No one ever apologized for the condition he was in. Not at all. I wouldn’t mind suing the hospital. S O N The complications that occurred were of such enormity that it really took the wind from all of our lungs. It was almost as if a tornado came in and out, and by the time the tornado left, there was a whole wake of questions, and conflicts, and emotional traumas and dramas. If anybody would have acknowledged some accountability, an apology, to actually reach out and connect with us on human terms—in human language. Not legalese, not the legality of a letter, primarily a sense that they were sorry, and that there is a willingness for them to be vulnerable enough to acknowledge that there might be an imperfection in the system. And, to acknowledge, by accountability , that the system can change. My mother wrote a letter to the hospital, and in that letter she discussed her concerns regarding my father’s care. All she got back was a phone call asking if she planned to pursue a lawsuit. My mother became furious when she received copies of bills indicating that our insurance companies have paid the hospital hundreds and hundreds of thousands of dollars for the care we felt led to our father’s death. The objective of a lawsuit is never, for me, about a monetary gain. It is for the education of the system. It is to put the system under a microscope such that the system itself can benefit . . . Time heals, but it doesn’t heal when there are so many questions that have not been answered. And that’s a very difficult thing for us still to be dealing with. MEDICAL ERROR AND CLINICIANS, PATIENTS, AND FAMILIES 3 This narrative captures the diverse ways in which trust and communication can break down between patients, families, and clinicians. It reveals the absence of transparency and respect coming from clinicians, the lack of accountability and continuity on the part of the hospital, and the dearth of kindness shown throughout the process. The case characteristically includes multiple missed opportunities over many months when clinicians and other hospital delegates might have initiated some repair...