Medical mistakes
13/09/14 05:07
I was listening to a TED talk recently. Actually I listen to quite a few of them. Most contemporary pastors have heard more than once, “Why can’t sermons be more like TED talks?” I suppose they can, but there are a few challenges, not the least of which is the fact that no one gives more than one TED talk each year and pastors are expected to preach every Sunday. I wonder if the most exciting TED speaker that you’ve ever heard had to give a different talk each week for a year - would that speaker be as exciting each time she or he spoke?
At any rate, this particular TED talk was by Brian Goldman, a Canadian Emergency Room physician. Goldman had been an excellent student - cum laude - and can remember being in medical school and working as hard as he knew how to learn as much as he could so that he wouldn’t be like some other doctors he knew - who routinely made mistakes.
The problem is that all doctors, even Goldman, are human. And human beings make mistakes. All doctors make mistakes. Some doctors make mistakes because of youth and inexperience - they learn from those mistakes and, hopefully, don’t make them again. But medicine is a complex mix of science and art and the human body is incredibly complex, so there are always new things to learn and new mistakes to be made.
Doctors make a lot of mistakes. The practice of medicine is filled with mistakes. One in ten medications administered in hospitals is either the wrong medicine or the wrong dose. Infections spread in and by hospitals are rampant around the world. It is estimated that over 24,000 people in Canada and over 100,000 people in the United States die unnecessarily each year due to physician errors. And those numbers are necessarily small simply because doctors and hospitals don’t talk about mistakes.
Goldman began to study physician errors. More precisely he began to study the culture of medicine and the way that errors are treated. He hosts a Canadian Broadcasting Corporation show about medicine and he interviews a lot of doctors. He began to ask, “What is the worst mistake you’ve ever made.” Most doctors grimace when asked that question. Then they pause. Then they will report a minor medical error: a missed diagnosis that some other physician saw, a medication error that caused a small discomfort, a bit of unnecessary pain suffered by a patient. Doctors rarely tell sorties in which the patient has died due to an error. It isn’t because they don’t remember. Goldman says, “You never forget the names of those who die.” It is that doctors often take decades to be able to talk of a mistake.
They make mistakes, but they don’t talk of mistakes.
That attitude is built into the medical system. It isn’t just doctors. Not long ago, I discovered a clerical error in hospital billing. A payment was made but not credited to the debt. I went to the office to straighten out the error. After some conversation and presenting my information a clerk finally recognized the error. She corrected the error and then said to me, “You should just have called. You didn’t need to come in.” I told her I didn’t mind coming in as long as the mistake was corrected. She repeated her instruction that I should not have come in. By then I was curious, because I thought it was strange that she couldn’t apologize for the error and the inconvenience it had caused. I thanked her for correcting the error. She repeated her instruction. Never did she say, “I’m sorry,” or “Someone made a mistake.” People who work in medical fields are carefully trained not to admit mistakes.
In fact, if you can get a doctor or other person in the medical field to speak of mistakes they quickly turn to blaming others. The most common thing you hear is that they don’t talk about mistakes because of lawyers and high medical malpractice rates. It isn’t quite as direct as “It’s their fault we can’t talk about mistakes,” but pretty close.
News flash! The leading cause of high medical malpractice insurance rates is not lawyers. It is medical malpractice. If there were no mistakes, if people weren’t severely injured and even killed by medical mistakes, there would be no juries to convict - no profits for lawyers. Admittedly trying to measure pain and suffering in dollars and cents is a strange scale and judgments are irrationally high in many cases. I think that reforming tort law is a good idea. But there is a real tragedy when people can’t admit and talk openly about their mistakes.
Science is based on learning from mistakes. Basic science looks for errors and corrects them. Theories are made and then work ensues to disprove them. Scientists are trained to look for errors in calculation, in methodology, and in all aspects of an experiment.
To the extent that physicians can’t talk openly about mistakes, they fail to learn from their mistakes. To the extent that they can’t talk about their mistakes they fail in a basic task of scientific medicine.
In practice, pastors may not be much better. But our culture is vastly different. We begin with the theological assumption that all humans make mistakes. We all sin. We all are in need of confession, repentance and forgiveness. We have a basic formula for human error: confess, change your ways, ask for forgiveness. Grace is only experienced by those who can admit their mistakes. And God gives second chances.
I don’t need a doctor who is perfect and who makes no mistakes. I have little use for the common condescension and assumption that doctors are smarter or better than the rest of us. I don’t buy into the theory that they somehow deserve to be paid more than other people. I’m more interested in a doctor that is human, who isn’t always right, and is willing to learn from mistakes.
For that physician, we need to change the culture of health care.
At any rate, this particular TED talk was by Brian Goldman, a Canadian Emergency Room physician. Goldman had been an excellent student - cum laude - and can remember being in medical school and working as hard as he knew how to learn as much as he could so that he wouldn’t be like some other doctors he knew - who routinely made mistakes.
The problem is that all doctors, even Goldman, are human. And human beings make mistakes. All doctors make mistakes. Some doctors make mistakes because of youth and inexperience - they learn from those mistakes and, hopefully, don’t make them again. But medicine is a complex mix of science and art and the human body is incredibly complex, so there are always new things to learn and new mistakes to be made.
Doctors make a lot of mistakes. The practice of medicine is filled with mistakes. One in ten medications administered in hospitals is either the wrong medicine or the wrong dose. Infections spread in and by hospitals are rampant around the world. It is estimated that over 24,000 people in Canada and over 100,000 people in the United States die unnecessarily each year due to physician errors. And those numbers are necessarily small simply because doctors and hospitals don’t talk about mistakes.
Goldman began to study physician errors. More precisely he began to study the culture of medicine and the way that errors are treated. He hosts a Canadian Broadcasting Corporation show about medicine and he interviews a lot of doctors. He began to ask, “What is the worst mistake you’ve ever made.” Most doctors grimace when asked that question. Then they pause. Then they will report a minor medical error: a missed diagnosis that some other physician saw, a medication error that caused a small discomfort, a bit of unnecessary pain suffered by a patient. Doctors rarely tell sorties in which the patient has died due to an error. It isn’t because they don’t remember. Goldman says, “You never forget the names of those who die.” It is that doctors often take decades to be able to talk of a mistake.
They make mistakes, but they don’t talk of mistakes.
That attitude is built into the medical system. It isn’t just doctors. Not long ago, I discovered a clerical error in hospital billing. A payment was made but not credited to the debt. I went to the office to straighten out the error. After some conversation and presenting my information a clerk finally recognized the error. She corrected the error and then said to me, “You should just have called. You didn’t need to come in.” I told her I didn’t mind coming in as long as the mistake was corrected. She repeated her instruction that I should not have come in. By then I was curious, because I thought it was strange that she couldn’t apologize for the error and the inconvenience it had caused. I thanked her for correcting the error. She repeated her instruction. Never did she say, “I’m sorry,” or “Someone made a mistake.” People who work in medical fields are carefully trained not to admit mistakes.
In fact, if you can get a doctor or other person in the medical field to speak of mistakes they quickly turn to blaming others. The most common thing you hear is that they don’t talk about mistakes because of lawyers and high medical malpractice rates. It isn’t quite as direct as “It’s their fault we can’t talk about mistakes,” but pretty close.
News flash! The leading cause of high medical malpractice insurance rates is not lawyers. It is medical malpractice. If there were no mistakes, if people weren’t severely injured and even killed by medical mistakes, there would be no juries to convict - no profits for lawyers. Admittedly trying to measure pain and suffering in dollars and cents is a strange scale and judgments are irrationally high in many cases. I think that reforming tort law is a good idea. But there is a real tragedy when people can’t admit and talk openly about their mistakes.
Science is based on learning from mistakes. Basic science looks for errors and corrects them. Theories are made and then work ensues to disprove them. Scientists are trained to look for errors in calculation, in methodology, and in all aspects of an experiment.
To the extent that physicians can’t talk openly about mistakes, they fail to learn from their mistakes. To the extent that they can’t talk about their mistakes they fail in a basic task of scientific medicine.
In practice, pastors may not be much better. But our culture is vastly different. We begin with the theological assumption that all humans make mistakes. We all sin. We all are in need of confession, repentance and forgiveness. We have a basic formula for human error: confess, change your ways, ask for forgiveness. Grace is only experienced by those who can admit their mistakes. And God gives second chances.
I don’t need a doctor who is perfect and who makes no mistakes. I have little use for the common condescension and assumption that doctors are smarter or better than the rest of us. I don’t buy into the theory that they somehow deserve to be paid more than other people. I’m more interested in a doctor that is human, who isn’t always right, and is willing to learn from mistakes.
For that physician, we need to change the culture of health care.