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October 18, 2018

Doctors need to learn how to make mistakes—and apologize

Daily Briefing

    In medical school, doctors learn "to examine, to research, to treat," but they don't learn how to apologize—placing doctors at risk of becoming "'second victims' of our mistakes," Sara Manning Peskin, a neurology resident at the University of Pennsylvania, writes for the New York Times'

    Learn 7 tactics to embed care standards in frontline physician practice

    Why doctors aren't taught to apologize

    While medical schools do spend time talking "about errors" and ways to take those lessons to improve technology or hospital policies to make them "human-proof," they don't teach doctors how to make and recover from mistakes, Peskin writes. "Nobody stands behind a podium and declares: 'Each of you will make mistakes, and some of them will hurt people,'" Peskin explains.

    Part of the problem, Peskin explains, is a fear of litigation. Peskin cites one study in which the researchers concluded, "'An apology is a statement of remorse, regret, and responsibility, and essentially proves a case for medical negligence.'"

    Further, Peskin writes, "Although most states have laws preventing medical apologies from being admitted in court proceedings, statements of fault are still admissible in most places." The result is, Peskin writes, "We can say, 'I'm sorry this happened,' but not 'I'm sorry I did this to you.'"

    Since physicians are not taught to handle "the emotional trauma of hurting a patient," Peskin explains, "most physicians cope with guilt, self-doubt and fear of litigation in private. " She continues, “After our patients, we become 'second victims' of our mistakes. '"

    A better way?

    But it doesn't have to be that way, Peskin writes, noting that other countries—like Sweden and New Zealand—have successful "no-fault" systems in place.

    Under the no-fault system, patients' request for compensation is based on injury from medical care rather than proof of negligence from a doctor. The cases are judged by medical experts instead of jurors, and compensation goes directly to patients rather than lawyers.

    A 'human doctor'

    As a doctor and a patient, Peskin understands the importance of a "human doctor."

    She recalls a patient who had been diagnosed with multiple sclerosis (MS). The diagnosis itself and the treatment crippled the patient's life. One medication Peskin ordered for the patient resulted in a severe reaction.

    Then, medical imaging suggested that the MS diagnosis was incorrect.

    Peskin saw the patient again and she still had no signs of MS. Peskin recalls their conversation: Peskin said, "I'm not sure I ever apologized to you, I'm sorry." In response, Shirley talked about her experience readjusting to a new life without a chronic disease. "We were back in a therapeutic relationship," Peskin writes. "She was my patient, and I was her human doctor" (Peskin, "Well," New York Times, 10/4).

    Learn more: 5 myths physicians believe about patient experience

    5 myths physicians believe about patient experience

    Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

    Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."

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