to the editor: The “Curbside Consultation” piece1
about revealing a medication error was good, but I disagree with the author's opinion that the discussion with a patient should simply end with the query, “Do you have any questions for me?”
In 1971, Dr. Fred Rehfeldt, a senior neurosurgeon who taught in our family practice program, gave me some good advice. He told me that if I ever made a significant mistake and as soon as I realized it, I should go straight to the patient (or family), say I had made a mistake and what it had caused, that I would set it right or, if preferred, summon a doctor I trusted to do so, and that I would pay the second doctor's fee and any hospital expenses related to the mistake.
The neurosurgeon said, “Don't go on about how sorry you are; just let them know you made an honest mistake and you'll do whatever you can to make it right. I've done this several times—and I've made some big mistakes—and I've never once had it backfire on me.”
About 10 years later I did that very thing—the only time in my career. I don't remember now what happened clinically. The part I remember was the strongly positive reaction by the patient's family. They not only kept me on the case, but the word went all around the little farm town about what a fine fellow I was. I learned many lessons from that, but the strongest one was the clear and strong feeling of rightness in dealing honestly with the patient's family.
Dr. Rehfeldt, may he rest in peace, was absolutely right.
in reply: I thank Dr. Daugherty for his reply. His comment about doing all he can “to make it right” brings up the issue of compensation. It is unfortunate that malpractice litigation is often viewed as the only way to compensate a patient for medical mistakes. In a poignant article,1
Dr. David Hilfiker recounts some of his own mistakes and states, “Rather than establish a ‘patient compensation fund’ (similar to worker's compensation), we insist that the doctor be sued . . . judged guilty.”
points out that our health care system has unrealistically relied on “individual error-free performance enforced by punishment” and that error prevention can best occur in a culture of “error recognition, accountability, honesty and rapid and fair settlement for injuries.”
Need litigation be the main option? Could recognition of errors and fair compensation for injuries both be accepted as an inherent part of our medical system?