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Education And Debate An ethical dilemma

Medical errors and medical cultureAn error of omissionCommentary: Learning to love mistakesCommentary: Doctors are obliged to be honest with their patientsCommentary: A climate of secrecy undermines public trust

BMJ 2001; 322 doi: (Published 19 May 2001) Cite this as: BMJ 2001;322:1236

Medical errors and medical culture

A junior doctor fails to read an electrocardiogram that has been ordered and the patient dies, undiagnosed and in pain, from a myocardial infarction. We asked a professor of medical ethics, an expert in medical errors, and two clinicians to comment on the ethical implications of covering up the mistake.

An error of omission

The patient, an elderly lady, was blind and deaf without speech. She had been brought in as an emergency case, clutching her abdomen and moaning. She had been like that for a couple of hours and had also vomited a few times. On examination she had some epigastric tenderness, her heart and lungs were normal, and her blood pressure was slightly low. Routine investigations were ordered; a drip was set up; and the team moved on.

On the next round the patient was still in severe pain. Nothing new had turned up. Her serum haemoglobin concentration, blood biochemistry, and chest and abdominal radiographs were normal. We hesitated about whether to provide pain relief. Antispasmodic drugs had been ineffective. An ultrasound scan ruled out problems with the patient's gallbladder. Endoscopy took another day to organise and produced negative results. The patient's pain and sickness continued. On the fifth day she died: the causes undiagnosed, her suffering unrelieved.

As house officer on the ward I had to prepare a case summary. Fishing in the pack of x ray films for the reports I caught the long strip of an electrocardiogram. It bore the date of admission. I had asked a nurse to do it as part of the routine work up but had not remembered to check the results. The textbook signs of an extensive acute myocardial infarction were plain even to my untrained eye.

I took the tracing to the senior consultant's office. He cast a glance over it then stared …

Correspondence to: S Fazel

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