Q: I often see patients I believe have been the victim of another doctor’s medical error. Do I have an ethical obligation to tell them I think they have not received effective treatment? Am I also obligated to tell the other doctor before I speak with the patient? How does one balance making someone aware that a mistake has been made with the imperative not to accuse someone falsely?
A: Everyone makes mistakes — even doctors. “Errors happen in medicine. They just do,” said B Aviva Preminger, a medical ethicist at Weill Cornell Medical College in New York City, who is also a plastic surgeon at Columbia University.
The centuries-old Hippocratic Oath obligates doctors to do no harm. Once that goal is accomplished, they must think about taking care of their patient in the best way possible. Sometimes that means having some uncomfortable conversations.
“While communication and understanding are not ethical principles in medicine, they are certainly essential in providing quality patient care,” Preminger said.
The dilemma is hardly limited to medicine — similar ethical codes are common among a variety of trades, from plumbers to childcarers.
In this case, “doing no harm” requires that the current doctor contact the former one, Preminger says. For one, it will help the newest physician understand the patient’s medical history. Careful, non-confrontational questioning will also help determine whether an error occurred and what the next steps should be.
There are at least two benefits. If the patient hasn’t suffered any harm, you are alerting the other doctor so he or she can learn from any possible mistakes. If medical complications or unintended side effects did arise, you’re giving the other doctor the chance to discuss the error with the patient directly.
If the former doctor doesn’t return calls promptly, “obtain old records if they are relevant,” said Preminger.
As for speaking to the patient, don’t bring up a possible mistake unnecessarily. Pointing fingers “generally only creates stress and anxiety for the patient,” she said. But if the patient’s health depends on knowing what happened with the prior doctor’s care — for instance, if he has developed a condition he will need to have treated — then it is up to you, the current doctor, to share this news.
The key to resolving the dilemma is gathering as much information as possible. Once you understand what happened, you will be in a better position to know whether this was an honest mistake. Just because something went wrong does not mean it was the doctor’s fault.
“Medical error and medical negligence are not one and the same,” Preminger said.
A similar theory holds true outside of medicine as well: an error at work is not always due to negligence or malfeasance on the part of an individual. Sometimes, it’s nobody’s fault, and the best course of action is to focus on making sure such a mistake does not happen again.
credit: BBC Capital