When things go wrong
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4226 (Published 15 October 2009) Cite this as: BMJ 2009;339:b4226
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Dear Tony Delamothe,
Although most of us would want to believe that we are
perfect and never commit mistakes, we all know inside that
human kind (doctors included) can never be perfect. “Let
perfection be thy aim” said Jesus. We are fallible. Now that
the world knows that truth, reports on doctors’ mistakes are
being published: the numbers have gone up exponentially
since 1990. Even the best of us will have to face those
situations. The guilt feeling could be eased by sharing the
truth with the patient and relatives. If the doctor has been
a good carer and has kept his/her records meticulously, open
discussion with the patient/relatives will only heighten
their faith in their doctor.
In a beautiful book- On Doctoring-edited by Richard Reynolds
and John Stone, published in 1991 by Simon & Schuster in New
York, there is an essay by David Helfiker, an American
physician and writer, entitled "Mistakes." It is such a
moving real life story that would bring tears to the
reader's eyes. The narration is a good guide for any doctor
in Helfiker's position.
He was evacuating the uterus of a young lady with four
consecutive negative pregnancy tests. He had almost gone
half way when he realised that he was mutilating a healthy
live foetus inside the womb! The story follows. It has to be
read in the original to be appreciated.
When bad things happen to good people, writes Harold
Kushner, the author of a classic by that name, that even God
feels bad and shares the sorrow! Our aim as physicians
should be to be honest one hundred per cent and learn from
each of our mistakes to be better doctors. One mistake could
be pardoned but the same mistake committed twice is
criminal. Primum non nocere.
Yours ever,
bmhegde
Competing interests:
None declared
Competing interests: No competing interests
Despite our best efforts, we are all fallible and make mistakes. Some of these mistakes are trivial, while others are serious, and even fatal. How can we best cope with our fallibility? First, we must recognize and accept our fallibility as inevitable. Second, we must provide safeguards for our fallibility, such as checklists and oversight by colleagues. Third, we must treat our mistakes with acknowledgment and apology, not denial and cover-ups. And finally, we must analyze our mistakes, in order to avoid repeating them. Fallibility is an inherent part of the human condition, and we must not be ashamed of our humanity.
Competing interests:
None declared
Competing interests: No competing interests
Misconceived endorsement?
Mr Delamothe (Editor in Chief) says: you can’t have one party breaching the confidentiality of a relationship while denying the other party the same right.
Prima facie it seems a sound argument. However,it is not correct in law as patients are not bound by confidentiality laws, and not a party to any confidentiality-led contract with their treating doctors[1].Thus, it appears, his endorsement of Jack Gilliat's rapid response is based on his own misconceived view on this matter.Further, as I have already indicated in my earlier response[1],the full GMC Guidance on Confidentiality lists a number of instances where a doctor could properly disclose information without prior consent of a patient. M Keegan of the GMC too, says[2] We accept that there can be a public interest in doctors responding to press criticism, i.e. if criticism has or might seriously undermine confidence in the individual doctor, a health service or the profession.But the contention that patients forfeit their privacy rights when they criticise a doctor is unhelpful.; this further confirms that there is no "denying" of rights of doctors as suggested by Mr Delamothe.
References
[1]http://www.bmj.com/cgi/eletters?lookup=by_date&days=1#222861
[2]http://www.bmj.com/cgi/eletters/339/oct12_2/b4173#222840
Competing interests:
see text
Competing interests: No competing interests