When M.D.s Mess Up

By Sanjay Gupta, M.D.

The blood-typing error that resulted in 17-year-old Jesica Santillan's being given the wrong heart and lungs was, by all accounts, an unusual mistake for the prestigious Duke University Hospital. Even rarer in some ways was the frank public acknowledgment of error by the hospital, followed by a sincere apology from her doctor. According to a study published last week in the Journal of the American Medical Association, that sort of thing doesn't happen often enough, especially for patients who desperately want more information about what's happening to them--both good and bad.

While we can be pretty sure that medical errors occur with some frequency--nearly 100,000 deaths a year are caused by such errors, one survey reported--it is less clear that doctors or hospitals will voluntarily own up to their mistakes. In a study published in 1991, 76% of the doctors surveyed said they had not fully disclosed a serious error to one of their patients. And a separate survey conducted last year found that only 30% of patients affected by a medical error had been informed of the problem by the health-care professional responsible for the mistake.

Why the disconnect? In part, it has to do with familiar pressures: fear of malpractice suits; potential damage to a hard-earned reputation; the awkwardness of admitting you were wrong. Indeed, doctors will tell you they are emotionally devastated by their mistakes and wish they could be more open with their patients.

But the communication breakdown may also have something to do with how patients and doctors define medical errors. After studying 52 patients and 46 physicians, Dr. Thomas Gallagher, an assistant professor of medicine at the University of Washington in Seattle and the lead author of last week's J.A.M.A. paper, concluded that patients define errors much more broadly than their doctors, including not just adverse medical outcomes but also substandard service and deficient interpersonal skills. Physicians, on the other hand, define errors quite narrowly, counting only clear deviations from accepted standards of care.

In the new survey, patients said they wanted to know about any error that could potentially cause harm, whereas physicians said that they would make exceptions when the harm is trivial or they think a patient might not understand the error or want to know about it. As far as apologies go, both patients and physicians agreed they were a good idea in principle. Doctors, however, were worried that saying "I'm sorry" could imply legal liability.

Despite all these concerns, attitudes toward medical errors are starting to change. Gallagher says there has been "a gradual loosening" among hospital administrators in charge of managing risk about the disclosure of medical errors. Rather than instructing physicians to be "spin doctors" and keep a cautious tongue, more and more hospitals are letting them be what they are: medical doctors who are human and sometimes make mistakes.

The most important message is the one patients should take home. "Don't be afraid to speak up if you think there has been a medical error," advises Gallagher. "Most doctors are committed to providing information but sometimes struggle with how to provide context," he says. When a patient initiates the conversation, that often helps open the channels of communication. And that's always healthier, for patients and doctors alike.