October 18, 2019

A doctor's near-fatal mistake—and her 'life-changing' apology

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Apr. 5, 2021.

    In the medical profession, many providers are hesitant to apologize to patients after medical errors, but Kate McLean, an OB-GYN, writes in the HuffPost's "HuffPostPersonal" that apologizing to a patient after she made a nearly fatal mistake during surgery "allowed [her] to connect in a way that actually made [her] better at [her] job."

    Tools to communicate across the physician enterprise

    A near-fatal surgery

    McLean's patient was an elderly woman who was in the hospital to have a cyst on her ovary removed. While the patient seemed ready for the surgery, her husband was nervous about the procedure, McLean recalls. He told McLean that he and his wife had "been married for 51 years, and we haven't been apart for more than a few minutes here or there since I retired. I wish I could stay with her now."

    McLean reassured him, telling him she would "take really good care" of his wife.

    The surgery started, and while McLean's attending supervisor was getting prepared, McLean and an intern started by inserting a Veres needle into the patient's abdomen through her belly button to begin robot-assisted laparoscopic surgery.

    But almost immediately after the insertion, McLean "heard the anesthesiologist gasp from behind the drape" that the patient was crashing.

    The surgical team jumped into action, with McLean starting chest compressions while the attending supervisor confirmed that the Veres needle hadn't caused any internal bleeding. "All I could think about was how much I wanted our patient to hold her husband's hand again," McLean writes.

    The patient's heart eventually restarted and McLean "sagged with relief, arms trembling," she writes.

    After careful inspection, McLean's team discovered the patient's liver was enlarged and had a small, "barely visible" puncture in it, McLean writes. The team wondered if an air embolus might have gone through the Veres needle into a blood vessel within the liver.

    The remainder of the surgery was "uneventful."

    The apology

    That evening, McLean reviewed her patient's pre-operative CT scan and saw that her liver was visibly enlarged, something that neither the radiologist nor McLean had noticed, McLean writes.

    The next day, McLean went to speak with her patient about what had happened. "My heart leaped into my throat," McLean writes, "because while I had been anticipating this moment, I still wasn't sure what to do." The incident, McLean recalls in her HuffPost piece, was "the biggest mistake I had ever made."

    McLean notes that in medical school, she was never taught how to talk to patients about medical complications. Moreover, McLean writes, she'd never seen one of her supervisors apologize to a patient before.

    Still, she felt she owed the patient an apology, so she gave it her best shot.

    "I'm so sorry I didn't notice your liver was in the way before we started the procedure," McLean told her patient.

    McLean writes that the patient "looked at me, searchingly," and then took McLean's hand and said, "Sweetie, the older I get, the more I've realized that nothing is certain. I knew something might go wrong when I agreed to the surgery. What matters is that you all solved the problem. It matters that you care this much."

    McLean writes that the experience "taught me that admitting a mistake didn't mean that I was a terrible doctor; in fact, it allowed me to connect in a way that actually made me better at my job. She saw exactly how much her safety and well-being meant to me."

    The case for apologizing to your patients

    Based on her own experience, McLean suggests that other doctors in some cases may benefit from apologizing to their patients. She notes that research has shown that doctors are often hesitant to apologize to their patients, likely because they overestimate the risk they may get sued, McLean writes. However, recent data has found that patients are actually less likely to sue when errors are disclosed and providers take responsibility. Apologies have also been associated with better legal outcomes for doctors as well, "[s]o, it seems that admitting to an error and doing the right thing is probably best for everyone involved," McLean writes (McLean, "HuffPost Personal," HuffPost, 10/16).

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