How should doctors respond when a colleague makes a mistake?
SEATTLE -- While Dr. Thomas Gallagher was completing his medical training, a man came into his hospital for cataract surgery. While the patient was under anesthesia, the hospital's ventilator malfunctioned and pumped too much air into one of his lungs, causing it to collapse and leading to a heart attack.
The patient survived and later returned to the hospital for cardiac care. That's when Gallagher discovered no one had informed the patient that his heart attack had been caused by a faulty ventilator.
"I thought, 'What am I supposed to do here?'" Gallagher said. "'Should I be the one to tell him there's a little more to the story?'"
Unfortunately, Gallagher - now a professor at the University of Washington - said medical mistakes like this one are not uncommon. It's tempting to think of doctors as flawless, perfect practitioners. But in reality, medicine is a human business. Even the most skilled surgeons and careful cardiologists make mistakes sometimes.
When a physician believes a colleague has made a harmful mistake, what should they do?
That's the question Gallagher is trying to answer. After gathering a group of experts together to discuss the issue, he has published an article of recommendations on the importance of reporting a colleague's mistake to the patient.
Changing a culture of collegiality
Gallagher said there has been a lot of emphasis in the medical community on disclosing one's own mistakes, but few have addressed how doctors should address a colleague's mistakes.
"We're hoping to change the culture in healthcare," he said. "At the moment, when something goes wrong with a colleague most physicians think the collegial thing is to cover for the colleague. That's been the status quo for a long time."
Gallagher said it can be difficult to confront a colleague when a mistake has been made. Physicians may be embarrassed, fear potential repercussions if they are perceived as disloyal, or be concerned about losing referrals. They may also receive mixed signals from healthcare institutions and malpractice insurers.
"Part of the change that we and others are working toward is to take away that sense of shame and stigma when care has not gone well, and make it the norm to talk with one another about quality problems," Gallagher said. "Everyone makes mistakes, so the norm should not be, 'How do I keep this to myself.'"
But, unreported medical errors can have serious consequences, Gallagher said. A patient's future medical needs may be improperly addressed, and those facing additional medical costs as the result of an error may not receive compensation they deserve.
When mistakes are ignored, physicians lose the opportunity to learn from them, Gallagher said.
"When we don't confront these issues head-on it keeps us from improving the quality of care."
Honesty is the best policy - always
To help physicians and institutions cope with this difficult situation, Gallagher and his co-authors have offered key recommendations in the article "Talking with Patients about Other Clinicians' Errors."
Gallagher argued patients have a right to honest information no matter how difficult it is for physicians to disclose.
He acknowledges the current system of medical malpractice makes addressing medical errors difficult, but argues patients facing additional medical costs as the result of an error must have all the information they need to receive compensation.
Now is the time to ask questions
Gallagher said clinicians are obligated to obtain all the facts when they suspect an error has occurred.
Patients' interests are not served by communicating inaccurate or speculative information, he said. Additionally, having an open conversation with a colleague gives them the chance to correct mistaken assumptions.
"Talk about what happened in the framework of curiosity rather than accusation," Gallagher said.
Create an honest environment
Finally, Gallagher and his co-authors urged institutions to provide leadership in bringing about these conversations, creating "atmospheres of trust in which people are encouraged, even rewarded, for providing essential safety-related information."
Many institutions have adopted disclosure-coaching programs to help facilitate peer-to-peer discussions, he said.
"To improve quality and safety we need to think about accountability as something we all do together."
Your doctor is not perfect
Gallagher has important advice for patients, too. He said patients should be glad when doctors report mistakes.
"Doctors and hospitals are trying to be more open when care has not gone well, so expect these types of conversations more regularly," he said. "It's not a sign that you have a bad provider. Institutions that are more open about care probably tend to be the ones that are providing higher quality of care."
Gallager said patients also need to better report their own concerns. In one survey he conducted of 100 cancer patients who believed something went wrong with their care, only 13 spoke up to their provider.
"Often times when patients think something might have gone wrong they keep it to themselves out of fear that if they raise a concern it will affect their care in some way," he said. "Recognize that speaking up is critical to patient safety. Patients should feel free to share their concerns about care and know a high quality healthcare institution will welcome those concerns."