So You've Made a Mistake: Now What?
By Curtis E. Harris, M.S., M.D., J.D.
Today's Christian Doctor, Spring 2002, Volume XXXIII, Number 2.
A Christian physician pours her heart and soul into her practice.* Christ is the model, the Great Physician, who healed both body and soul. A sincere desire for a moral, ethical and competent witness dominates the daily prayers and dedication of most, if not all, Christian physicians. The emotional devastation caused by a bad outcome, a therapeutic failure, is especially severe when a physician genuinely cares for his patients. The deeper the concern, the greater the damage. Self-doubt, second-guessing, guilt, depression, isolation and withdrawal are virtually normal reactions to the unintended injury of a patient from a treatment or surgery gone bad, whether an error was made or not. But the depth of the physician's emotional reaction is greater, longer lasting, if in fact his negligence caused the harm. To be accused of doing wrong in the face of innocence is troubling, but to be accused of doing wrong in the face of guilt is humiliating.
In this regard, we are our own worst enemies: we accuse ourselves more severely than anyone else can or will. We forget that negligent errors are not intentional errors, but, rather, are merely mistakes. Every human makes numerous mistakes every day. Mistakes are not moral lapses, any more than the fact that, because we are alive, we must interact with our imperfect world. Further, we judge our mistakes by the severity of the outcome, not by the seriousness of the act itself. Small errors with big con equences become more important than big errors with small consequences. Why is this true? Stated imply: We love our neighbors (our patients), hate human suffering and seek only the best for those we care for. Suffering that we somehow caused hurts us more hen it is great. We would do anything to make it right.
Making it Right
We can respond to the pain we feel by becoming defensive, blaming the patient, a nurse or even another physician. We can justify our actions to the extent of totally covering our i takes. Though very common, neither blame nor justificaon is the correct way to respond. Let me suggest a successful process I have seen others use, that is based on biblical principles.
First, look at the second Great Commandment-to love others as we love ourselves. Begin the process by treating yourself with dignity and kindness. You did not intend any harm; in fact, it was quite the opposite. Had you intended harm, you probably would feel very little----or none----of the remorse you now experience. Your error, assuming it was an error, was at worst careless, and at best out of your control. Understand that if you could take it back, you would. Feel comfort in your discomfort.
Second, look at the facts carefully. You were there, you know more about what happened than anyone else ever will. Be objective. Far too often, we second-guess ourselves. If we know the end of a book before the beginning, the book is dull and uninviting. Recognize that not knowing is part of the adventure of life. We can all imagine other choices that we believe would have made things better, but that is not the point. Was what you did the best decision at the time, knowing what you knew then? Would you do it again? You may decide to change how you do things in the future to allow other choices in the same situation. Good! You have learned from experience; you are now more wise. But that does not mean what you did was wrong. If necessary, find someone safe to discuss this with. Take your time with this step; it is the most important part of the process. If, after all is said and done, you believe you made an mistake, that you did something you would not normally do, then go to the next step.
Third, go to the literature. I cannot tell you how many times I have seen physicians imagine that how something is done in their small community of physicians is the way it is done everywhere. For example, non-treatment may be the preferred course for a disease in Rochester, but treatment is preferred in Dallas. There is far more disagreement about what is or is not the standard of care than you may realize. You may even learn something important for your future practice when you look at an issue carefully. Do not assume you know the answer to the standard of care.
Fourth, don't escalate your emotional response. Things may not be as bad as you think they are. In fact, they are usually not. There is the story of the man whose car had a flat tire, late one night on a deserted road. When he looked in his trunk for the jack, he realized he had left it at home. He saw a farm house with the lights on in the distance, about two miles away As he walked to the farm house to ask for a jack, he talked to himself. First he mumbled "I really shouldn't bother that fellow; he's probably had a hard day." Next, "I bet he will really be upset when I knock this late." Just as he walked up the long driveway, the lights in the farmhouse went out. He thought: If he gets angry about me knocking on the door this late, I wonder if he will do anything? What if he has a gun? And then quickly he thought: If he has a gun'. he'll think I'm an intruder and shoot me! How dare he! All I need 1s to borrow his jack, and he's going to shoot me! What kind of man is he? o shoot me! By the time he pounded on the door, he was furious. When the sleepy, startled farmer came to the door, before he could say anything, the man yelled "I don't want your stinking jack anyway!" And then he stormed off down the driveway. The moral of this little story? Don't imagine you know what someone else is thinking. And don't let your anxiety turn into anger.
xiety turn into anger. Fifth, tell the truth.** In this recommendation, I am probably going to say some things that would make your malpractice attorney cringe, but I think they are correct, nonetheless. If you still have the chance, tell the patient or her family what you think happened. If you had a part in the bad outcome, admit it. Don't take any more or any less of the responsibility than is real or appropriate. Don't try to shift the blame to others, and don't volunteer to blame others. Often, your patient already knows what you did or didn't do, or at least has some good idea. Studies have shown that, in more than 85 percent of cases, if the physician had just not tried to cover up, the patient would have both forgiven her and respected her for her honesty. Just as importantly, if you are honest, you may have the chance to seek both forgiveness and restitution, a chance that is lost by the time an attorney becomes involved. One caveat: If your patient has filed a malpractice suit or intends to do so, the moment for telling the patient your version of what happened is over. Seek legal counsel. Avoid talking to the patient.
Finally, continue to tell the truth, regardless of what happens. Even if the patient decides to see an attorney, and you become embroiled in the legal system, tell the truth. Tell your attorney if you think you did something wrong. Let him, and any experts that may become involved in the case, give you their opinions. If you still believe you made an error, stick with your convictions.
Let me tell you a true story. I have several friends who are attorneys-a sorry but true fact. One is a well-known plaintiff's attorney in Oklahoma. I knew him as a non-practicing Christian, until one day I saw him in church, reunited with his estranged wife. Later I had the chance to ask him what had changed. He told me of a Christian physician he had recently sued for a client who had died. The physician had refused to play the "blame game," and instead had openly admitted his mistake in misreading an X ray. His client "won" the case: it settled out of court. But it was the physician who had impressed the attorney. The physician's witness for the truth had been so powerful, so unusual, that the attorney began to look at his own cynicism toward people and God. He realized that he had been as dishonest in his faith as he felt doctors were in admitting their errors. After facing himself as a liar, the man rededicated his life to Christ, on his knees in his office. I again recently, years afterwards, and he remains a changed man. The lesson in this for me was: We never know what good God has in store for us and others, when we do His will, regardless of the cost. The physician continues to practice, respected for his integrity and quality of care. The family is no longer as angry; they have had their "day in court," and believe the truth won out. And the attorney ... well, you would just need to meet him today.
In Africa, there is a saying: "Safety is in the roar of the
lion." When lions hunt their prey, the old, toothless males sit on the far end of a field and roar, driving the game into a trap set by the young females, silently crouched, ready to kill, on the other side of the field. Too often, instead of facing our fears with courage and prayer, we flee the roar of the lion, only to discover that we are devoured by ourselves. So you've made a mistake: Now what?
*The masculine and feminine pronouns are used randomly to avoid awkward sentence structure.
**The reason for this recommendation will be the subject of a future article.
Curtis E. Harris, M.S., M.D., J.D., has been in the private practice of endocrinology for nearly twenty years in Oklahoma City, Okla. He is an adjunct professor of law. He has testified as a medical expert on numerous occasions over the past ten years. He is a member of the CMDS Board of Trustees. (1997).