Today I read an article in Medscape regarding the issue of whether or not a physician should tell their patients if they make a mistake in the medical care of the patient. You can read the article here.
I have suffered greatly because of physicians’ medical errors.
The first time, was in 1991. I had a D&C for a miscarriage. After the procedure I continued to have bleeding and began to develop severe abdominal pain. I informed my physician and the office said to make a follow up appointment. I had the D&C where I lived and it was far away from my work place, so a secretary at my office got me in to see her doctor at the medical school clinic. Over a course of three weeks, I saw five physicians. None of them could figure out what was wrong with me. One of the doctors, did a pregnancy test. She asked me if my stools were dark and I told her they were. My pregnancy test was still highly positive. She brought up the possibility of a tubal pregnancy but after consulting with the head of surgery she told me that wasn’t a possibility.
My last clinic appointment was with the head of surgery. He examined me and reviewed my case and concluded that I was a post-partum neurotic. He gave me a Demerol shot and advised me to go home. Fortunately, a urologist I had seen was there and he said he thought something was wrong with me. He said he was going to admit me to the hospital and he sent me down to GYN for a sonogram.
After they performed the sono, the doctor pulled out a huge, long needle. I asked what they were going to do. I was informed that they saw pus on my sono so they were going to extract it via my vaginal canal.
After they began the procedure, the physician turned towards the intern and told him to page the surgeon stat for emergency surgery. He told me I had massive bleeding in my abdominal cavity.
They rushed me into emergency surgery. I remember the doctors running down the halls pushing my gurney to the OR, all in slow motion. A nurse told me I might not survive. Fortunately, a top specialist in fallopian tube repair was on call. I had a ruptured tubal pregnancy, not post-partum neurosis. The specialist successfully repaired the tube.
After surgery, the urologist came in to apologize to me. He told me that I had a tubal pregnancy. All the doctors assumed because I had a D&C that I couldn’t have a tubal pregnancy. The surgeon who repaired my tube had been a professor of the doctor who did my D&C. He called the doctor and asked him the results of the D&C pathology report. It showed no fetal cells. Physicians are routinely supposed to read pathology reports after surgery, but the physician said it had been misfiled. The doctor who repaired my fallopian tube told my original physician to call me immediately and apologize to me, which he did.
Fortunately, everything turned out okay. I had a baby boy two years later. Obviously this happened because of slightly unusual circumstances, tubal pregnancy, but there was gross physician error involved.
Did I feel better that the physician apologized. Yes I did. I still was angry that none of the other physicians, especially the head of surgery, did not come to see me after surgery and apologize. Did I consider suing? It crossed my mind but since I was in the medical profession I knew that there was no case because there was no loss of organs.
The second incident occurred in 1997. I was having right sided abdominal pain. I consulted a GYN and she told she would do surgery to remove abdominal adhesions. She did a laprascopy but found massive adhesions. Without informing me or my husband or obtaining a surgical consult, she converted the surgery to a laparotomy. When she was trying to remove adhesions, she accidentally injured three nerves in my abdominal area.
After surgery I had trouble walking and severe abdominal pain. She told me both symptoms would pass and sent me home. For two weeks I difficulty walking and severe pain. I saw her for a follow up visit. She told me the surgery went well and that she thought I had a psychosomatic disorder that caused my pain. She explained to me stress can do things to the body and put me on antidepressants.
I tried to see her again but she refused to see me.
I suffered with this pain for years and over the years it got much worse. No one could figure out what was wrong with me. I ended up seeing a pain management doctor for treatment of my symptoms.
In 2003, we moved and I saw a pain specialist who was a neurologist. He did some testing and told me I had reflex sympathetic dystrophy which is a chronic pain syndrome. He said after reviewing my records, my disorder had likely developed after a complication in the abdominal adhesion surgery. I obtained my medical records. We discovered what she had done. Did I file a lawsuit? It was too late to pursue any legal recourse. Was I upset? Tremendously so. It has affected my whole life. I am tortured every day by severe pain.
Do I think that physicians should tell patients when they made an error in their treatment? Of course. When you as a customer pay for services you expect to be informed if any errors occurred in the performance of your service. What do you do when your accountant makes an error in your tax return, your mechanic doesn’t fix your car as he or see promised, or an appliance you were sold doesn’t work? You complain to the appropriate people and expect an apology and an assurance that the problem with be fixed if possible. If the service provider is unable to fix the problem, you expect some compensation.
So why do so many physicians not tell their patient about medical mistakes? I think because as medical students, physicians come to understand that telling patients about your mistakes just isn’t the thing that doctors should do. They should be seen by their patients as a person with superior knowledge in the medical field so the patient will be able to trust them. Also, their medical malpractice insurance is ridiculously high and they are afraid that they will be taken to the cleaners in court.
First of all, almost all medical malpractice claims are settled out of court. I have done quality peer review of patient cases with physicians. Most people who find out that a medical mistake in their care end up not suing. They may threaten to sue but often change their mind when they find out how difficult the process to recover any damages may be.
The attitude of the physician as the great healer, keeper of medical knowledge, and the condescending “protective” relationship of the doctor to the patient should have been thrown out years ago. Today’s medical consumer is much more likely to want to know what is going on with their care and they also have more tools to research their illness via the Internet. Doctors say that medical information on the Internet is incomplete and full of errors. That is true, but a large part of the population of people are educated, especially the baby boomer generation. They are use to obtaining and receiving information where and when they want it. And half of the doctors look up medical information on Wikipedia!
So, as the baby boomers mature into their elder years, I believe the consumer movement in health care will explode with thousands of people seeking information about their medical histories and care. It will probably change the practice of medicine.
I think the role of the doctor today should be that of patient advocate. The doctor should be a team member in providing good medical care for the patient. He or she should encourage their patients to become informed and welcome their efforts to find out information regarding their condition. If the doctor is able to communicate with the patient about their knowledge and continues to encourage good communication between the patient and the doctor, it is reasonable to assume that misunderstandings that lead to threats of lawsuits will decrease tremendously.
Many physicians say that they will not tell their patient about any mistakes they may have made in their patients medical care. Consumer trends and new governmental reform may force them to reveal more information. They should get used to providing information to their patients.