You hear about the biggies: the ones that make the papers, the ones that have the hospital staff buzzing. The ones that might end up being analyzed by quality management teams or during a morbidity and mortality conference: a megadose of potassium killing a patient, a wrong leg amputated, a lung mass missed on an X-ray.
Few, if any, hear about the "near misses" and "close calls." The uncomfortable reality, though, is that the little mistakes occur far more frequently than anyone would care to admit. And while most of us keep them to ourselves and may eventually forget them, it's plain that we can learn as much from the little ones as we can from the whoppers.
Here is a "little one" of my own.
I was returning calls for a colleague who was out of town. A Mrs. Dessaint answered the phone. In a soft southern drawl, she told me that her husband had asked her to call in for his cholesterol result.
As medical students, we're taught that without specific permission from the patient, we shouldn't give out results to anyone else. But many of us do it anyway, particularly if the results are normal. For whatever reason—our patient load is overwhelming, we're backed up on charts—we just don't have time to keep calling.
And that was one of those days. It was late, it was raining, I was rushing to make a train. Cradling the phone between my left shoulder and ear, standing over my desk with my coat on, I found the chart among the five or six that remained on my desk and opened it to the lab section. Mr. Dessaint was young, just thirty-four, so I didn't expect any surprises. Normal. Normal. Normal. "Looks pretty good," I heard myself saying into the receiver, "normal cholesterol, normal blood sugar." I flipped to the previous page. And stared.
Gonorrhea culture: positive.
An uneasiness washed through me. I lowered myself into my chair. I told Mrs. Dessaint that one test had come back abnormal, but I couldn't give out any further information; her husband needed to call back himself. From the way she paused, I could tell she suspected it was something bad. How could she not? Her voice creased with concern, she told me her husband was working the late shift and wouldn't be home until eleven o'clock.
Was it better to leave her imagining the worst—and I was sure she was thinking cancer or HIV—or just tell her the truth? It was unlikely that waiting the few days until Mr. Dessaint called back would lead to any adverse health effects. Still, I couldn't help myself from picturing a double screen image: on one side, a delicate Mrs. Dessaint in the emergency room, shaking with chills, blood leaking from her vagina, a festering abscess growing on her fallopian tubes; on the other, her swaggering husband stopping off at a local strip joint to talk up some tart with double D breast implants. She deserves to know, I thought. It's curable. She should be tested right away. In the end, she'll be grateful.
The words spilled out. She gasped. I heard the phone clatter to the ground. I told Mrs. Dessaint what she needed to do and hung up. Heart pounding, I grabbed my bag, dashed through the gray drizzle to my car, and sped to the station. I made the train just as the doors slammed shut.
In retrospect, my lapse of judgment seemed stunning. This was privileged information. Absent explicit permission from the patient, I would never tell a patient's husband that her mammogram showed a suspicious mass. I would never give someone other than the patient an HIV test result. What I had done was extraordinarily presumptuous: not taking a moment to consider how upsetting it might be to hear—from a doctor, no less—that your husband had a sexually transmitted disease with promiscuity written all over it.
At the same time, gonorrhea was a reportable disease, and it was indisputably my duty to inform. Of course, it...