Skip to main content

Complications - When Doctor Commits Mistakes


When a new doctor is learning for the first time or when a senior doctor is learning or not learning a new technique, who suffers? Naturally, a patient. When we visit a doctor with a physical problem as a patient, we expect perfection. But it is not easy to get. So, we have to understand how the doctors may make mistakes.


We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, all enterprise of constantly changing knowledge, uncertain information and fallible individuals. It is not only science but also habit, intuition and plain guessing. This article is about dealing with mistakes made by doctors and their remedy.

When do doctors make mistakes? 

For whatever reasons like,
     hubris,
     inattention,
     hesitation,
     wishful thinking, or
     the uncertainty of the moment,
the standard required treatment is missed.

Some common mistakes:
  1. Large metal instrument left in patient’s abdomen.
  2. The biopsy was done on the wrong breast.
  3. During heart operation, a small key step is skipped.
  4. The doctor assumed kidney stone with CT Scan and found big abdominal aortic aneurysm.

We call such doctors ‘negligent’, ‘incompetent’ or ‘unethical’ and act by malpractice lawsuits, media scandal, suspension or minimum firing. And still, the central truth remains:
In the medicine field, all doctors make terrible mistakes.

1991: New England Journal of Medicine did Harvard Medical Practice study of 30,000 admissions.

The study found:
  • 4% hospital patients suffered complications from treatment, resulting in disability or death.
  • 66% of them were due to an error in care.
  • One in four or 1% of admission involved actual negligence.
  • 44,000 patients die each year, at least partly, as a result of errors in care.

1995 Study: ‘Mistakes in administering drugs’ – wrong drug or wrong dose leading 1% with serious consequences.

Anaesthesia: American Society of Anesthesiologist has “VIGILANCE” as their Keyword because anaesthetist takes control of breathing, heart rate, blood pressure and all the vital functions and complete control of patient’s body.

Anaesthesia has inborn dangers due to human errors, carelessness or negligence.
  • Starting of general Anesthesia through thought to be dangerous, it is not. It is the middle of Anesthesia because of vigilance in waning.
  • Mistakes in managing the airway, misconnection of tubing for breathing, inadequate familiarly with equipment, inadequate experience, haste, inattention, fatigue and poor communications amongst team are major causes of problems.

Autopsy: Autopsy means “to see oneself”.
  • Doctors are instructed to request an autopsy on everyone as a means of confirming the mistake of diagnosis if any.
  • Today, we have MRI, Ultrasound, Nuclear Medicine, molecular testing and what not. So, we wrongly think we do not need an autopsy to find out the cause of death.
  • Beware, Autopsy studies tell (1) One third (33%) of the misdiagnosis of the patients would have been expected to live if its proper treatment has been administered and (2) Two out of five (40%) who die due to the wrong diagnosis and still we fail to improve over time. (3) Lastly, physicians missed a quarter of fatal infections, a third of heart attacks and two third of pulmonary emboli in their patients who died. In fact, Physicians fail to order perfect test or scan which was already available.

Mistakes during 'Learning':
  • Skill, surgeon believe, can be taught tenacity can not.
  • I am, I have found neither gifted nor maladroit. With practice and more practice, I get the hang of it.
  • Practice, it turned out, did not necessarily make doctor perfect.
  • As patients, we want both expertise and progress. In fact, they are just contradictory desires. There should be no learning curve as far as patient’s safety is concerned, but that is entirely wishful thinking.
  • You cannot train novice doctor without compromising patient care.
  • Do we ever tell the patient that because we are still newer at something, the risks are inevitably higher and that we are likely to do better with others who are more experienced?
I have never seen it.

It would certainly be a graceful and happy solution. We would ask patients-honestly, openly and they would say yes.

In general, while learning patiently does eventually benefit often enormously but the first few patients may not and may ever be harmed.


2. Good Doctor Going ‘Bad’


Even good doctors can go bad; and where they do, colleagues tend to be almost entirely unequipped to do anything about them.
  1. Goodman, renowned orthopaedic surgeon, highly respected sought after and busiest doctor one time, started doing wrong surgery and hurting patients.
  2. Shipman, a physician, killed more than 300 patients giving a lethal dose of narcotics.
  3. Brown, a surgeon without a license, killed a patient of gangrene by wrongly doing an amputation of a healthy patient.
  4. Burt, a gynaecologist wrongly did hundred of disfiguring clitoral circumcision and vaginal reshaping without consent.

Causes of losing medical skill:
  1. Alcoholism
  2. Addiction to narcotics tranquilly and barbiturates
  3. Serious mental disorders: major depression, mania, panic disorder or psychoses
  4. Ill, old age and distracted by their own difficulties
At any given time, 3 to 5% of practising doctors are actually unfit to see patients.

Colleagues do not do anything because it is easy, or so to say, no one has the heart for it.


Symptoms (Behavioral events)
  1. Persistent poor anger control or abusive behaviour
  2. Bizarre or erratic behaviour
  3. Severe obsessive-compulsive disorder
  4. Transgression of proper professional boundaries
  5. Incurring a large number of lawsuit and complaints

Can Computer replace Doctors?
  • From the first day of medical training, it is clear that errors are unacceptable. So there is a quest for machine-like perfection in the delivery of care and so the doctor should be trained to act like a machine.
  • Human beings are inconsistent and human are not good considering multiple factors and reasons.
  • Now a day, systems have been designed to read their X-rays, mammograms and nuclear medicine heart scans.
  • No doubt, something vital is lost by machine and medical care is about life and death and so we always need doctors to help us understand what is happening and why and what is possible and what is not.
  • No doubt machines can decide, but we still need doctors to heal. Doctors have to serve as knowledgeable guide and confident.

Who should decide the treatment plan – patient, doctor or both?

Patient autonomy gives full right to decide. “Informed consent form” describes all the complications and possible treatment outcome. Signing this means you (patient) have understood and accepted the risk. It was not long back when the patient was relying on doctor’s decision; in fact, a good physician cannot simply set aside when the patient makes a bad or self-defeating decision.

So, is there any remedy to this problem? Can we let doctors keep taking decisions, and ensure not making mistakes? Let’s look at options.



Is there a remedy?

M & M 'Morbidity and Mortality' Conference

A place where doctors can talk candidly about their mistakes not with patients, but with one another. When things go wrong, it’s almost impossible for a physician to talk to a patient honestly about mistakes. At most, a doctor might say “I’m sorry that things didn’t go as well as we had hoped.
  • The honoured doctors meet once a week. Thursday, 5 PM with the amphitheatre.
  • Laws protecting its proceedings from legal discovery.
  • Here they can gather behind closed doors to review the mistakes.
  • No one can cover up the mistake.
  • It is said, “if you are not a little afraid when you operate, you are bound to do a patient a grave disservice.”
  • The M & M we learn “mistakes are an inevitable part of medicine.”
  • The M & M sees avoiding errors as largely a matter of will – of staying sufficiently informed and alert to anticipate the myriad ways that things can go wrong and then avoid problem by anticipating before it happens.

Professional Assessment Programme by Kent Neff, MD

Neff’s Professional Assessment Programme with Abbott Northwestern Hospital at Minneapolis, Dr Neff established a centre for assessment of fitness for pilots, judges and doctors in the Hospital Campus. He did assessing very thoroughly and dispassionately. Steps:
  1. Gather Information from many interviews with the concerned person. Made to tell their story, again and again, half dozen times. Ask the colleagues around about his work and Nature.
  2. Full Physical Examination: Full medical check-up including any illness laboratory and radiological surgery.
  3. Psychological test:
  • a) This lead to arrive at an exact diagnosis of depression, drug addiction or psychoses.
  • b) Decide whether a doctor is fit to return to practice.
  • c) Specific recommendation to follow regarding the treatment plan. 

Yes, mistakes are human and doctors are no exception. To expect total perfection from doctors is too much. Doctors and society should be aware and awake to remediate them by either morbidity and mortality conference or professional assessment programme.


Reference

Book title: “Complications: Notes from the Life of a Young Surgeon”
Author: Dr Atul Gawande, M.S
Publisher: Penguin Books Ltd., England (2002)
Page: 270, Price: Rs. 350

Dr Atul Gawande, a surgeon performing surgery became a writer with scalpel pen! Outlook describes him as a doctor who understands his patients beyond their illness. He has also written “Better”, “Being Mortal” and “The Checklist Manifesto”.

He is a surgeon at Brigham and Women’s Hospital in Boston, U.S.A. He is also a staff writer for the “New Yorker” and a professor at Harvard Medical School. He lives with his wife and their children in Newton, Massachusetts. 





Written by,
Dr Bharat M. Desai
Desai Eye Hospital, Bilimora
(M): +91-99240-63045 | (E): bharat@desaieyehospital.com

----------------------------------
Readers' Comments Related Articles
----------------------------------

Comments

  1. The M & M 'Morbidity and Mortality' Conference that you mentioned, is it something specific to the U.S.? Does it also happen in India? It would be worth knowing how candid doctors in India can be.

    On one hand how recent unfortunate events of beating the doctors have increased in different corners of the country, the ignorance (and in some cases genuine mistakes) by the doctors have been long existent in our country. Especially in remote places or backward localities many doctors consciously malpractice with the sole focus on commercial gains. I know my point side-tracks from the original topic of this article, but you being such a senior in this field, what is your take on it? Can we ever expect such doctors in our country to be caught and put to justice?

    ReplyDelete
    Replies
    1. M & M conferences are ideal places for doctors to develop.

      This system has not worked even in US, forget about India.

      Unfit doctors and dis -honest doctors are big threat to humankind. Only fellow colleague and staff working with doctor know and notice the finding about doctor loosing skill due alcoholism, social stress or physical inability. Their duty is to report this soon either to the concerned doctor asking him/her to to stop medical practice or should be reported to government authority to force him/her to stop practicing.

      Such ideal things are academic and never to happen facts.......

      Delete
    2. That's an interesting fact... and unfortunate that it's greatly prevalent in our society. I guess it's the 'commercial' view point that restricts any right-doing in this case, from all - the doctors, their colleagues as well as the victim patients and their families.

      Delete
    3. The take-home message is that great trouble exists amongst medical professionals and ideal Medical management is far to get.

      For getting ideal and ethical Doctors, society has to be ideal and ethical, because Doctors are part of present day society and have not born as Gods. To expect ideal is near impossible.

      Delete
  2. This comment has been removed by the author.

    ReplyDelete
  3. very true , i work in health care and i have seen this happening very closely. It's easy for a patient to say but it takes time to achiever expertise and doing practically.

    ReplyDelete
    Replies
    1. Thanks, Twinkle, for being first to respond. Yes, expectations of patients have gone very high due to new technology, but it is not easy.

      Delete

Post a Comment

Optionally, you can also email your feedback directly to the author.

Readers also liked:

We Are Alive To Live Only

While writing a book review on novel one has to be cautious in not telling the details, so that reader still needs to read the actual novel, on the same time they should find the basic details of the story in the review. Yes, I will do that.

We Are Alive To Live Only is a story revolving around three young people in their twenties, namely Suhana from Kolkatta, Raahi from Surat and Joy from New Delhi. They meet and a novel is created in Mumbai. You have to read the novel to know how they become friends and how around ten years pass.



મારું વસિયતનામું

માંદગીમાં સારવાર અને મરણ વખતની ક્રિયાઓને લાગતું વસિયતનામું 
મારી સાંઠ વર્ષની ઉંમરે મે મારી આત્મકથા લખેલી તેમાં મારી માંદગીની સારવાર અને મૃત્યુ પછીની વિધિઓ મારા પત્ની અને બાળકો જેમ કરશે તે મને મંજુર રહેશે-એવું વિધાન મે કર્યું હતું. હા, તે વાત હું હજીપણ એમની એમ જ સ્વીકારું જ છું પરંતુ, હવે દસ વર્ષ પછીના મારા વિચારોનો ખ્યાલ આવે એટલા પૂરતું આ પત્ર લખું છું. 
મારી શારીરિક તકલીફોનો ઈલાજ કઈ રીતે કરાવવું તે બાબતે કમસેકમ મારા પોતાને લગતા કેટલાક ખ્યાલો મે નક્કી કર્યા છે, તેનું વિગતવાર વર્ણન હું કરીશ.


જો બેભાન ન હોઉ અથવા કહો કે માનસિક રીતે નિર્ણયશક્તિ ગુમાવી ન ચુક્યો હોઉ તો, મારી ઉંમરને લગતી કોઈપણ માંદગીની કેવી-કેટલી અને ક્યાં સારવાર કરાવવી તેનો નિર્ણય હું લઈશ. પણ હું બોલીને કે બીજીરીતે કહી ન શકું એમ બને તો માર્ગદર્શક બને એ રીતે સારવારની વાતો કહીશ.

Anavils - An Endangered Community

After Parsis, Anavils (Anavil Brahmins, અનાવિલ બ્રાહ્મણ ) are the fastest decreasing community. The total population of Anavils around the world does not exceed two lakhs figure and that is also fast reducing day by day. Days are not far, beyond a century or so, when they will have to be seen/found in records, photos and videos. Why?

Because,
   - they get married too late,    - many are dying unmarried,    - they wait for the career to be settled before the first (and maybe the only) childbirth.

Destination Wedding

While attending my niece Khushbu’s wedding (Dr Hirak Desai’s daughter) at a party plot in Valsad, my other niece Guddi (Mrunmayi Janak Desai) suddenly coined the phrase 'destination wedding'. My vocabulary evolved with a new phrase, with a special meaning. It is a special type of wedding hosted at a location, usually far away from home.

Here, the guests reach the venue and stay for a couple of days with all the people involved in the wedding celebration. The hosts plan the wedding and send the invitation with the details of stay, events, dress code and explaining the rituals planned to be followed. Yes, this is the same conventional wedding we’ve always seen, but with creative ideas of enjoying, dancing, playing games and simultaneously conducting the wedding in an authentic manner. It is a bit costly affair for the hosts, but I’m sure they are prepared for it.

Karmic Theory (Law Of Karma)

“Facing Challenges and Creating Destiny” by BK Shivani, Gurgaon
National Conference on Mind-Body-Medicine, Mount Abu.
August 6-10, 2010
What is Karma?

Karma is work or energy going out in the form of 1. Thought, 2. Word and/or 3. Action. Resultant return of energy is in the same amount known as Bhagya (Destiny). The role of God is to ask you to do Karma and to help you to do RIGHT karma. Then whatever good/bad karma you do, the result is accordingly and entirely your responsibility. Because the result is Destiny (Bhagya). So don’t blame anyone else or God for anything bad. Do not try to blame someone responsible for your own deed and its result.

Jainism: Simplified

I am introducing here world spread religion having 5.5 million followers, mainly in India and abroad like USA, UK, Canada, East Africa and many other countries in one of the six greatest religions. Word "Jain" is derived from "Jina" meaning conqueror. "Arihant" is one who has destroyed his inner enemies like anger, greed, passion and ego.


Gujarat – Introduction And History

A student of History has to understand Geography, Economics and Anthropology simultaneously. A person curious to know about world history has to proceed step by step, learning his own state first, then country and then only one can understand world history. Well, appreciating above facts, I am starting my study with History Of My State Of Gujarat. I have put it in order of time and later described important states and rulers.

કાર્તિકેય

કાર્તિકેયના જન્મની વાત

તારક નામ ના અસૂરે દાનવે દેવોને હરાવ્યા હતા. તેને મારવા માટે દેવોએ શું-કરવું તે વિચાર્યું તેને તારક ને મળેલા વરદાન મુજબ તેને ફક્ત નાનું બાળક દ્વારા બનેલું અને માર્ગદર્શિત લશ્કર જ મારી શકે એમ હોવાથી તેઓએ બ્રમ્હાનો સંપર્ક કર્યો. બ્રમ્હાના કહેવા મુજબ ફક્ત શિવ-પુરુષ દ્વારા ફક્ત એકલાથી પેદા થયેલ બાળક – ફક્ત ભગવાન શંકર જ આપી શકે ભગવાન શંકર ને મોહિત કરવા “કામ” ને મોકલ્યો પરંતુ શિવ તેને “ત્રીજી આંખ” ખોલી ને ભશ્મ બનાવી દીધો. ત્યારે તેમણે શક્તિ પાર્વતિ ને આજીજી કરી. પરંતુ આ ભગવાન શિવને પાર્વતિ મનાવી શક્તિ નથી. પરંતુ પછીથી દેવો અને પાર્વતિ ની વિનંતી ગ્રાહ્ય રાખી શિવ છ ચમકારા જેવા અગ્નિ રૂપે બીજ એટલે કે વીર્ય આપે છે તેથી કાર્તિકેય ને સ્કંધ (વીર્ય દ્વારા જીવીત) પણ કહે છે.

આવા શક્તિશાળી અને ઉષ્ણ બીજને અગ્નિને દેવો આપે છે. અગ્નિ બીજને ગરમ હોવાથી સાચવી શક્તિ નથી, ત્યારે પવનને આપે છે. જે વાયુ- પવન ગંગામાં પધરાવે છે ત્યાં પાણી ઉકાળવા માંડે છે અને બારું ના જંગલમાં આ વીર્યમાથી આગ લગતાં,બચેલા અંગારામાથી છ બાળકો ઉદભવે છે. માં માટે રડતાં તડપતા છ બાળકો માંથી છ માથાવાળું એક બા…

History Of Muslims In India: Hindu-Muslim Relations

With this article, I would like to tell you about three things: (1) History of Islam and Muslims in India; then I will try to elaborate, specifically telling (2) What went wrong; and finally I will conclude telling (3) The future of relations amongst Muslims and Hindus.


Although it is routine to give references, in the end, I shall start with the list of three reference books in the beginning. All these details are not mine, I’ve only summarized them from these books.

ભગવાન શિવ શંકર – ભોલેનાથ

શિવ – શંકર – ભોલેનાથ તરીકે
ભગવાન શંકર નો પરિચય ભોલેનાથ તરીકે અવરનવાર આપવામાં આવે છે, તે અમસ્તો નથી. તેના ભોળપણ ના અસંખ્ય દાખલાઓ તેમના જીવનમાથી જોવા મળે છે, તેથી આ વાત સાબિત થયેલ છે. તો, ચાલો,તેની વિગત મેળવીએ.

ભગવાન શિવ દુનિયાદારીથી તદ્દન અજાણ હતા એટલે તેમને લગ્ન કેવી રીતે થાય, લગ્ન પછી ઘર કેમ જોઈએ અથવા લગ્ન પછી શરીર સંબધ શા માટે જરૂરી તેની બિલકુલ ખબર નહોતી.