Posted by John Ager on 14 November 2013.

Medical mistakes kill over 400,000 people each year.  Ethically and morally, health care providers are obligated to tell patients when they make mistakes, but, of course, not all of them do.  For example, physicians detect medical errors all the time, but often there is little incentive to confront a colleague.  It easy to understand why a physician might not want to tattle on a respected friend or co-worker.  The culture in medicine is one of “I’ve got your back.”  It is likely to be embarrassing.  Privately, it may not be encouraged by medical institutions and malpractice insurers.  And, exposing someone to the threat of litigation drives home the “there but for the grace of God go I” sense of vulnerability.  Still, there must be a fundamental commitment to self-regulation which is at the heart of the medical profession and the doctor-patient relationship.  So what’s a doc to do?

A recent article in the New England Journal of Medicine, which you can find at http://www.nejm.org/doi/full/10.1056/NEJMsb1303119, offers some guidelines about who should report medical errors and how it should be done.  The overarching principle is that potential medical errors need to be explored and addressed, not ignored swept under the rug.  No surprise there.  When an error is suspected, the process should start with a colleague-to-colleague conversation about what occurred, not a rush to judgment.  Supportive, respectful communication is the key, just as it is with patients.  If a potential mistake is identified, additional discussion about how to inform the patient and any institution will be necessary.  The guidelines encourage a collective approach involving both individuals, and, to an even greater degree, institutions.  Such an approach to figuring out medical errors may be challenging, but it is necessary to fully meet the needs of patients and their families after a medical error has occurred.

Health care providers have incredible power over the lives of their patients.  With great power, however, comes great responsibility.  That includes a responsibility to put a patient’s right to be treated with respect and honesty before the interests of the health care provider, as painful as “telling” or owning up to a mistake may be.