When a mistake happens, patients want to hear all about it in direct terms -- what went wrong, the implications of the error, why it happened, how it can be corrected, and what is being done to make sure it doesn't happen again. And they want the doctor to give the information spontaneously, without having to ask a lot of questions.
Most doctors would prefer to be less direct, putting the best possible spin on the information, maybe not even saying directly that a mistake occurred.
The one thing they do have in common, says a report in the Feb. 26 issue of the Journal of the American Medical Association, is a need for emotional support that often cannot be given because of constraints imposed by the American medical and legal systems.
Medical errors have been a center of attention lately, since an Institute of Medicine report estimated they are responsible for 100,00 deaths a year in the United States. The problem was exacerbated over the weekend with the death of a teenaged girl after Duke University doctors gave her a heart and lungs from a donor with the wrong blood type.
Dr. Thomas G. Gallagher and his colleagues at the University of Washington School of Medicine put together 13 focus groups -- six with patients only, four with doctors only, and three with a mix of doctors and patients to discuss the subject.
They were presented with two error scenarios. In one, the patient gets a dose of insulin that is tenfold too high, because the doctor's order for "10 U" is mistaken for "100 U." The patient goes into intensive care but eventually recovers without damage. In the other, the patient develops abnormal heart rhythms caused by too-high levels of potassium because the doctor forgets to look at the results of a blood test.
The doctors' replies indicate that "physicians might not be providing the information or emotional support that patients seek following harmful medical errors," says the report. On the other side, "physicians were also upset when errors happen but were unsure where to seek emotional support," and so "institutions should also address the emotional needs of practitioners who are involved in medical errors," the report says.
The study confirm the findings of another assessment that was done to examine the medical training needed to improve safety in medicine, says Jonathan VanGeest, a consultant to the National Patient Safety Foundation, which conducted the assessment.
Both the University of Washington study and the one that VanGeest help set up report that doctors are under tremendous pressure because of medical errors -- not only because of the possibility of a malpractice suit but also because their reputation is on the line. "I'm supposed to hit a home run every time up," the journal quotes one doctor as saying.
Both studies accept the inevitability of errors, since no system and no person is perfect, and look at ways of acknowledging that an error has occurred that limit the trauma for both doctors and the people they treat. However, programs to reduce the incidence of errors are also under way.
"This is the start of a series of projects," says Gallagher, a professor of medicine and of medical history and ethics. "We are doing a survey of physicians to try to quantify some of these attitudes, and we are planning to train health-care workers in how to disclose errors."
"A training program is being developed," VanGeest says. It will be designed to help doctors deal with the "really top three areas that are critical in medical errors," he says -- medication safety, legal questions and cultural restraints on physicians.
One organization that gives information on medical errors and what is to be done about them is Duke University, which admitted its mistake in the transplant girl's death. You can also try the National Patient Safety Foundation.