The Role of Punishment in Medical Errors

Surgeons operating on patient The Sunday New York Times just had an interesting Sunday Dialog, entitled, “Handling Medical Errors.”

The original letter was written by a former chief executive of Beth Israel Deaconess Medical Center relaying an event at his hospital where a surgeon operated on the wrong ankle of a patient. While this medical error was an egregious “never event” -type of error, he felt that no punishment was necessary and very articulately and humanely explained why. He noted that the physician already felt horrible, that punishment does not act as a deterrent (generally speaking, health care providers do not want to commit errors), and that punishing health care providers only pushes the reporting of errors underground.

A variety of persons responded to this letter. Surprisingly, to me, a fellow surgeon said that he hoped that that the offending surgeon was sued for malpractice. He also indirectly said that he thought the surgeon should be punished. What do you think?

Is there a difference between holding someone accountable and punishing someone? If so, what is the difference? Should health care providers be both held accountable for errors and punished?

While I think we’d all agree that health care providers should be held accountable for their actions, punishment of health care providers for medical errors is questionable. Punishment, in the form of punitive actions, by supervisors and/or one’s institution, are rarely seen as productive. Fear of punishment may prevent deliberate, wreckless actions, but most medical errors are unintentional and committed by well-intentioned providers. So, for errors committed by well-meaning providers, what does a “punishment” accomplish? Shame? Embarrassment? Hardship?

And, we all know that there already is another form of punishment and accountability –being sued for medical malpractice. So, I don’t think a symbolic, additional punishment is either prudent or effective. Health care providers should be supported during times of medical errors –just as patients should be. Energies for all parties involved should be focused on recovering from the error, correcting it, if possible, and learning from such errors on both a personal and institutional level.

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