Dealing with Clinical Errors in Practice

We have all made some mistakes in caring for patients. We started our evening by speaking in general terms about what type of errors we have made along the way in our careers.  Some of these are rather simple mistakes in choosing a medication or not knowing a drug interaction. Some are errors of clinical judgment that we only come to realize when the patient suffers a complication.  In reality there are innumerable ways each of us can and have screwed up over the years.  We then discussed in general terms the root causes of errors that can be made. These can include lack of knowledge, technical expertise, inattentiveness, and judgment.  Rarely, we see medical mistakes made due to willful neglect.

No matter what the error is or the cause of that error, we all agreed as physicians we feel a tremendous amount of responsibility for it and it weighs on us greatly. This sense of regret that we feel is probably one of the greatest burdens we bear as physicians. We spent some time sharing how we each deal with these emotions and responsibilities. Some of us go into a bit of a shell and work it out on our own and others somehow find relief by speaking with trusted colleagues about these errors.

We then turned to the Scripture, specifically Psalm 51, to try and relate some of these feelings with what David had experienced in his life. Psalm 51 is David’s lament after Nathan had come to him and exposed David’s Adultery with Bathsheba. In choosing this Psalm we are not saying that committing these medical errors is a sinful act like David’s but rather the type of regret he felt is analogous to what we go through when we are being weighed down with concern.

In Vs 1-2 there is the cry to the Lord to wash away this problem. We discussed how often that is the first strong desire when dealing with a mistake is to just wish it away and have God erase it.  In Vs 3 the writer admits that the error was their’s alone. It was agreed that this is an important part of resolving a mistake is taking responsibility for it. We discussed how sometimes people have difficulty doing this and they try and “pin the blame” on someone else – sometimes even the patient.

Many of us are involved with teaching residents and have the opportunity to teach based on our experience. In Vs 13 it says we should teach others God’s ways. God. Of course, would desire us not to have made errors. We made the point that part of our responsibility is to teach residents and other staff about these errors and hopefully help them from occurring in the future. Often the burden of the mistake is lifted once the problem has been discussed in this manner.

Being open and honest with the patient is essential for rectifying the situation. The most important thing to do is to explain the error to a patient and the family. Keeping lines of communication open is the number one way to avoid a lawsuit and will restore the doctor-patient relationship. In Vs 17 we are instructed to have a contrite heart which God will not despise. Trust that the Lord can renew and get you through this time. Lastly, we looked at Vs 10-12 and also Phil 3:12b-13 which asks God to renew us and strengthen our spirit. We agreed that we can not let these errors define us and that as Christ followers who have been called to do the work of physicians we need to “forget what is behind and strain toward what is ahead.”

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