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Saturday, August 4, 2012

Errors Should Be Admitted

I'm having surgery on my ankle for the second time in a few days.  The first surgery was two years ago for a spiral fracture of the fibula after a fall on snow and ice.  No, it was not a fun ski trip, just one of those home accidents when your front yard is a 45 degree incline.  After the surgery, on the lateral side of my left leg, I always complained of pain on the medial side of my left leg.  It never got better.  For two years, I have literally had "pain and suffering" complete with afternoon swelling of the left ankle.  My ankle was misaligned.  So finally, I went to get the famous second opinion.  The orthopedic surgeon took one look at the x-ray and said, "They didn't fix your deltoid ligament."  What, that obvious?

In the medical field mistakes get made.  Unfortunately, sometimes with grave consequences with patients.  At the end of this blog, I have listed several evidenced-based sources that back up the position that early disclosure to patients and family members is not only the right thing to do, but also leads to less monetary costs for the healthcare institution.  Best practice hospitals are disclosing errors and offering settlements early to patients who have been harmed.  This helps to restore trust in the healthcare institution on the part of the patient.

I have sat in discussions with families when these disclosures were made.  As difficult as the words are to say, the family members need to hear them.  I would have bet that the families would have filed medical malpractice suits, but in these cases, what they want is to be assured that proper measures have been taken to prevent this from happening again.

I have also been present when it was obvious that nothing was going to be disclosed to the family yet they knew that things were not right.  Their anger would be dealt with.  If the medical professionals fail to deal with patients and family members, the legal professionals will. 

I met a gentleman last week who was on crutches and in a cast.  I asked him what happened and he told me how he broke his foot, then he told me about the doctor that put his cast on too tight.  He lost feeling in his toes, called the office on a Friday and was told to come in to have it checked on Monday.  He went to the ER and was found to have cold toes.  The cast was immediately removed and after his circulation was restored another cast was applied.  That was a close call that could have resulted in a loss of toes or a foot.  Frequently is the case that bad outcomes occur when medical professionals simply don't listen to what the patient says.


Betty Ann Bowser of PBS NewsHour in April 2011 reported the following:

•A study published in Health Affairs examined the records of 795 patients at three teaching hospitals.

•354 of the patients had experienced medical mistakes.

•“90 percent of all hospital mistakes go unreported.

”To read the entire article, click on New Study Finds Medical Error Rates are Underreported. To read the entire study in Health Affairs, click on ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured.



For those of you thinking that there is nothing in this posting for you, here it is.  If you manage people, and you make a mistake early disclosure is the best course of action.  The stakes can be fairly high.  Make an error with payroll and you can be liable for corrective action going back 3 years.  I have had the opportunity to sit down and speak with Ladies and Gentlemen about HR issues that needed to be addressed.  Our workforce is more intelligent than some want to give them credit for and when we lay issues on the line and explain what our needs are, they are willing to meet us half way.  People have to experience our honesty to have an opportunity to respond to it as professionals. 


Berlinger, N. and Wu A. (2005). Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error. J Med Ethics. 31:106-108. http://jme.bmj.com/content/31/2/106.short

Gallagher, T. and Lucas, M. (2005). Should we disclose harmful medical errors to patients? If so, how? JCOM May 12:5 http://www.turner-white.com/memberfile.php?PubCode=jcom_may05_patients.pdf

Gallagher, T. and Studdert, D. (2007). Disclosing harmful medical errors to patients. N Engl J Med. 356:2713-9. https://secure.muhealth.org/~ed/students/articles/NEJM_356_p2713.pdf

Greene, L. (2008). More apologies to families follow medical mistakes. St. Petersburg Times. http://www.tampabay.com/news/health/medicine/article775911.ece

Kachalia, A., Kaufman, S. Boothman, R., Anderson, S., Welch, K., Saint, S., and Rogers, M. (2010). Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program. Annals of Internal Medicine 153:213-221.

Kraman, S., Hamm, G. (1999). Risk Management: Extreme Honesty May Be the Best Policy. Annals of Internal Medicine. December 21: 131:963-967. http://www.annals.org/content/131/12/963.short

Lamb, R. (2004). Open disclosure: the only approach to medical error. Qual Saf Health Care 13:3-5 http://qualitysafety.bmj.com/content/13/1/3.extract

Liang, B.A. (2002). A system of medical error disclosure. Qual Saf Health Care. 11:64-68. http://qualitysafety.bmj.com/content/11/1/64.short

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