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Columns

First, Do No Harm

Does the Hippocratic Oath extend to medical mistakes?

By Gina Yu

Next month will be the 20th anniversary of the day my father permanently lost vision in his left eye due to a fatal surgical error. Currently, this eye is slightly shriveled, glossed over, and completely blind — a physical reminder of the frustration my father felt as a victim of medical malpractice. Exacerbating this already tragic situation, my father never received a clear answer regarding why this complication occurred because his surgeon avoided any inquiries about the subject. Almost all medical malpractice testimonies share this common theme of unanswered questions and helpless frustration. If anything, my father was “lucky” to realize his predicament days after his surgery. Dr. Frederick S. Southwick, for example, shares how a surgical mistake 17 years ago eventually resulted in amputation of his left leg.

Before embarking on an arguably justifiable rampage of the quality of America’s modern healthcare malpractice system, let’s stop to consider what compelled these surgeons to avoid admitting these mistakes. From the doctor’s perspective, there are several compelling reasons to not admit preventable errors. These include today’s negative stigma associated with making mistakes in medicine and a lack of meticulously accurate quality inspections in medicine, which more easily allows doctors to get away with their mistakes if they so choose. It’s difficult to imagine why doctors wouldn’t want to keep their mistakes secret given the negative consequences they face if a mistake proves fatal, including losing a patient’s trust, millions of dollars in a malpractice case, and even a medical license. In order to persuade doctors to admit their mistakes, we need to create an environment with more compelling reasons to own up to their errors rather than keep them hidden.

In the early 19th century, doctors could comfortably admit mistakes and were even encouraged to do so as potential teaching opportunities. Of the few malpractice cases conducted during that time, most were decided in favor of the doctors, and patients were castigated for accusing doctors of making grievous errors without admission, even if such an error actually took place: clearly an unjust time for the patient, but modern medicine has evolved by increasing the patient’s authority in a patient-doctor relationship. However, the increasing frequency of malpractice cases and high expectations of quality medicine, given advancements in medical technology, has created an impossibly high standard for doctors. While in the past, people assumed doctors as inherently perfect beings — “a cultural hero” whose word was trusted as right without question — today, people demand doctors be perfect and meticulously scrutinize them to find anything that seems wrong. Combine this new perspective on doctors with several other factors like decreased intimacy in the patient-doctor relationship and increased commercialization of medicine, and you now have an impersonal business model where little sympathy is given to doctors that make mistakes. We as patients trust doctors with our lives, and we expect perfection, though doctors are human and will inevitably make errors. No wonder so many doctors have an inner God complex.

Physicians recognize how stigmatizing medical mistakes creates such a turbulent environment, and they encourage us to change our perspectives. Professor Henry T. Greely of Stanford University argues that a cultural shift needs to take place before doctors will readily admit their mistakes. Medical doctor Atul Gawande shares a striking story of how a mistake he made almost cost a woman’s life and how he could not even express his mistake among his colleagues without feeling extreme shame and guilt for this natural human occurrence. In an ideal world, doctors would admit mistakes and acknowledge and accept the consequences, and patients would be more forgiving should a mistake occur. However, it is difficult to make such a lofty request of both doctors and patients in this situation, given the life-altering consequences these mistakes can have on the patient.

Instead of asking doctors to bravely accept their fates and patients to blindly forgive a physician who makes a fatal error, a more likely and perhaps equally effective solution would be to reduce the stigma of medical errors and realize that they are, unfortunately, an inherent part of the medical practice — given how complicated the processes are and the human propensity for error. If doctors were encouraged to admit mistakes — unlike my father’s surgeon, who shied away from the subject — patients can take immediate preventative action to fix the mistake, and future generations of doctors can learn from these mistakes as well.

Until we force doctors to admit mistakes or even tape their proceedings, choosing to admit mistakes is a moral dilemma with the wrong incentives. Unfortunately, there is no simple solution to encourage doctors to discuss errors, especially given the multitude of personal reasons why each doctor might choose not to. But by changing our somewhat idealized perception of medicine, we can at least encourage doctors to not be as afraid to admit when they do wrong,

Gina Yu ’13, a Crimson editorial writer, is a biomedical engineering concentrator in Dunster House. Her column appears on alternate Thursdays.

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