What To Do When It's Not Your Error
Much has been written about physicians addressing and acknowledging errors to patients, but little has been written about how health care professionals should address each other regarding errors and even less has been written about how to address each others’ patients when a colleague has committed an error –especially when it directly impacts a mutual patient’s care. Often there is a “culture of silence” surrounding errors and a thought that talking about errors can make the threat of malpractice worse and/or that it may not be appropriate to address another colleague’s error with a patient.
While caring for a patient, have you ever encountered an error made by a colleague? At the very best, it can be awkward, and at the worst, you may worry that it can embroil you in a medical malpractice lawsuit and/or your colleague, too. So, how should a physician handle the medical error of a colleague? A recent New England Journal of Medicine article, entitled, “Talking with Patients about Other Clinicians’ Errors” tackles this tough issue.
While it has been well-established that patients have the right to have errors disclosed to them, today’s care model is very complex, with patients often seeing several physicians at the same time. With this model, errors may be discovered by a physician who did not commit the error. And, there may even be a debate as to whether there actually was an error and if/how it should be disclosed –especially if the offending physician insists there wasn’t an error. And, all of this, combined with ideas of professional courtesy, lack of comfort or training in having such sensitive conversations, and notions about institutional risk management, add to the barriers.
Often, a physician’s instinct may be to try and “piece together” what happened by going into the medical record without directly contacting the offending physician. While this may seem more “collegial,” it is not advised from a risk management standpoint and it does not necessarily give a complete picture of a physician’s reasoning, the circumstances, etc.
While the article lays out a very sophisticated level of discussion and is definitely worth the read, it, overall, gives three main take-aways:
1. Patients and Families Come First. Because patients have an ethical right to know about medical errors, awkwardness, anxiety or fear of disclosure are not acceptable reasons to ignore possible errors.
2. Explore, Do Not Ignore. No matter how obvious an error may seem, a physician should always contact the offending colleague first, to make sure that he or she has all of the facts and truly understands the situation. The article gives great suggestions as to how to frame the discussion, so it can be as fruitful and collegial as possible.
3. Institutions Should Lead. As it is with any good policy, it should be supported by the larger institution. Cultures of transparency and communication should be expected and cultivated. This is especially important for patients suffering significant harm from errors.
In addition, there is also an excellent table, entitled, “Disclosing Harmful Errors in Common Situations Involving Other Clinicians,” presenting 5 common scenarios that physicians may encounter and how to proceed in those situations.