发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: What Should I Do If I Witness a Medical Error?
发信站: BBS 未名空间站 (Wed Feb 4 08:49:15 2009)
What Should I Do If I Witness a Medical Error?
If I see an attending or resident commit a medical error, what should I do?
Should I tell the patient or
report the problem to someone else?
Response from Megan Fix, MD
Attending Physician, Maine Medical Center, Portland, Maine
Medical errors are prevalent, often times preventable, and are the
responsibility of each and every
member of the healthcare team. Even as a medical student, you have a duty to
protect your patients
and keep them safe. Witnessing a physician make an error puts you in an
awkward position, but the
more you feel empowered to protect your patient, the easier it will be to
As reported in the landmark paper, "To Err is Human," between 44,000 and 98,
000 deaths per year are
due to medical errors. Many of these errors are preventable. Do not
underestimate your role as part
of your patient's safety net. You can help prevent these errors and also
help disclose them when they
In a recent article by 3 medical students, 1 student explains how she helped
intercept a potential error
when a patient was improperly prepped for surgery. She spoke up, not once
but twice, so that the
patient could be re-prepped. Even within the medical hierarchy, your
communication is important. In
that moment, she put the patient first and helped avoid a potentially
When medical errors occur, it is our duty to disclose them. Truthful
disclosure is good for patients.
Recent evidence shows us that most patients actually prefer to know about
medical errors that have
happened to them. Furthermore, surveyed patients said they would be less
likely to sue if they were
informed of the error by the attending physician.
So now that you feel empowered to prevent and help disclose medical errors,
how do you do so? The
easiest way is to be direct and honest in a respectful manner. You are never
wrong if you put the
patient first. Remember that you are a part of a team.
Get the facts in a nonjudgmental way. Was this a medical error due to
equipment or dispensing of
medication? Medical students are still in the role of the learner. It never
hurts to say something like,
"this may be a ridiculous question but..." or "I may be mistaken, but..."
This is a respectful way to ask
what is right for the patient and oftentimes, once the error is identified,
both you and the attending
physician can then respond and inform the patient together.
Be a team member. You may feel compelled to "tell" on the attending
physician or resident who
committed the error, but this will not only undermine your relationship with
the patient, it will also
create distrust and lack of confidence within the whole medical team. As
part of the team, your goal is
to work with the attending physician to disclose to the patient or to make
the error right. One way is to
respect the authority of the attending physician by asking for their
assistance. This can help deflect
possible defensiveness that may arise. For example, you might say, "I spoke
with Mrs. Jones and she is
very concerned about X. I would like your help discussing it with her." If
that does not work, then
approach your resident. Again, put the patient first as in, "I was concerned
about our patient when I
saw Y. I'd like to talk to the attending physician, will you join me?"
Remember that the attending physician has the ultimate responsibility. If an
error is made, it is his or
her job to disclose the error to the patient. You may help protect your
patient by asking the attending
physician to disclose, but it is not your job to do it alone. If you are
having difficulty, ask for a second
opinion from a trusted faculty member or an ethics committee member.
I encourage you to read a series of medical student essays on this topic
from JAMA. In 1 excellent
essay, Courtney J. Wusthoff beautifully summarizes the role of the medical
student in an error
In determining a course of action, the medical student must consider duties
to the patient, physician,
and him- or herself. It is inappropriate for the student to unilaterally
disclose the error, yet the student
must not allow the patient to be deceived.
Medical errors will happen, and when they do, we must maintain our duty to
the patient. Even though
we all make mistakes, most of us want to do the right thing. In these
situations, the right thing is to put
your patient first and act in an ethical and respectful way.
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