Tuesday, January 1, 2008

Health Blog of the Day

Sandeep Jauhar's Blog

His latest op-ed; Explain a Medical Error? Sure. Apologize Too?

He was 30, a Pakistani man with a long face and a disconnected look, which I attributed to anxiety. I asked him about the pain. It had started after dinner the night before, lasting about 10 minutes. He had slept comfortably, but the pain recurred while he was walking to the bus stop that morning, persisting almost an hour. It was a dense pressure in the center of his chest. To be on the safe side, he had decided to leave rounds and come to the E.R.

His blood tests were normal, as was his first electrocardiogram. He had none of the traditional risk factors for heart disease. I suspected he was suffering from acute pericarditis, a usually benign inflammation of the membrane around the heart often treated with over-the-counter anti-inflammatory drugs. Characteristic of pericarditis, the pain worsened when he took a deep breath. I told him that if blood tests in six hours were normal, we would send him home. I joked that there were easier ways to get out of internship duty....

I received a call about an hour later asking me to come over to the lab. When I arrived, the angiogram was playing on a computer screen. It showed a complete blockage of the left anterior descending artery, the so-called widow-maker lesion. The artery looked like a lobster tail, unnaturally terminating after several centimeters. Within minutes, the blockage was opened with a balloon and a stent.

Afterward, in the control room, heat rose to my face as colleagues wandered in to inquire about what was going on. “How could we have missed this?” I asked aloud. I was well aware of the disturbing prevalence of heart disease in South Asians, whose risk is up to four times that of other ethnic groups. I knew that heart attacks in this population often occurred in men under 40, who often do not exhibit classic coronary risk factors. I knew all this, but somehow my mind had suffered a block....

What now? I knew I had to explain myself, but how much should I say? Like all doctors, I had made errors before, but never one this big — and in my own specialty, too. Should I just tell my patient the facts? Should I apologize?

Most doctors are afraid to take responsibility for medical errors. We are acutely aware of the potential hazards — legal and professional — of taking ownership of a mistake. But studies have shown that physicians’ apologies do not necessarily increase malpractice lawsuits. In fact, they may protect against litigation. Seventeen states have enacted legislation encouraging such apologies, some even making physicians’ expressions of remorse inadmissible in court.

It was not always this way. Hospital legal departments routinely used to advise doctors never to admit responsibility for an error.

For Discussion
: Is the Hippocratic Oath consistent with what doctors practice nowadays- 'legal medicine'?

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