To err was fatal

BMJ 1996; 313 doi: (Published 21 December 1996) Cite this as: BMJ 1996;313:1640
  1. Carlo Fonseka, professor of physiologya
  1. a University of Kelaniya, Ragama, Sri Lanka

    Error free patient care is the ideal standard but in reality unattainable. I am conscious of having made five fatal errors during the past 36 years.

    After two years in state hospitals I joined the staff of my medical school in Colombo in 1962, holding the posts of lecturer, senior lecturer, associate professor, and professor of physiology. In all that time I have practised medicine because I believe that direct contact with patients makes my teaching more relevant.

    In recounting the stories of my fatal errors the problem of guarding patient confidentiality arises. The BMJ has changed its policy from guarding anonymity to getting consent.1 In the most recent three of my five fatal errors, obtaining informed consent from relatives was easy. With regard to the first error, which occurred in 1960, and the second which occurred well over a quarter of a century ago, relatives could not be tracked down. So trying to achieve anonymity by changing names and some of the details was the best I could do. The British Medical Journal is not only British, it is also truly international. Wouldn't it be guilty of a species of ethical imperialism—the opposite of cultural relativism—if it refused to publish material about patients dead for nearly three decades or more, merely because written consent for publication had not been obtained from relatives who cannot be traced?

    I find myself paralysed by doubts about how best to recount the case histories. It was Hippocrates who reputedly introduced the case history to medicine. The idea that diseases have a natural history is traceable to him.2 It is, of course, possible to recount the history of an illness without revealing much about the sufferer. To do so would not serve the purpose of this paper.

    First fatal error

    The 23 year old labourer …

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