If things go wrong
Even though we all know that to err is human, few of us can easily accept our own mistakes. This is probably more the case in healthcare than in most other occupations, because errors can have such serious consequences. In a survey of MPS members who had experienced untoward incidents in their practice, almost all of them found that it shook their confidence and eroded their job satisfaction.
Complaints from patients tended to be taken as personal attacks, with the doctor feeling angry, hurt and betrayed. Some of these effects lasted for years. The intensity and duration of the emotional aftermath does not seem to relate closely to the seriousness of the error or the nature of the complaint; the crucial factor is the ability of the individual doctor to put the experience into perspective and seek out practical and emotional support. Lessons can be drawn from this:
In a survey of MPS members who had experienced untoward incidents in their practice, almost all of them found that it shook their confidence and eroded their job satisfaction
- Assess the circumstances realistically – don’t blow an error or a complaint out of all proportion; remind yourself of all the things you do get right and all the patients who are satisfied with your care.
- Talk the matter through with trusted colleagues and friends who can both empathise with you and give you a realistic assessment of the situation.
- Contact MPS for practical assistance in dealing with a complaint or claim and for advice about handling the emotional repercussions.
- Learn from the situation. If you did make a mistake, acknowledge it. Report it as an adverse incident and engage with your colleagues in developing strategies to prevent similar errors occurring in the future.
- If you have been unjustly accused of substandard care, think what may have brought the accusation about – was it a communication problem, for example? How might you have handled it differently?
- If a patient has complained about you, try not to react defensively by avoiding the issue or making counter-threats. The hospital will handle the complaint, but you should be prepared, if it turns out that you have made a mistake, to give the patient their due – a full face-to-face explanation, a sincere apology and an assurance that you will take steps to avoid a repetition of the problem.
- If, after the complaint has been investigated, it is evident that the complaint has no foundation, you might still consider seeing the patient to explain the outcome of the investigation, give a full account of events and try to ascertain whether the complaint has been caused by a misunderstanding that you can put straight.
The Medical Council gives the following guidance on open disclosure about adverse incidents:14
“Patients and their families are entitled to honest, open and prompt communication with them about adverse events that may have caused them harm. Therefore you should:
- acknowledge that the event happened,
- explain how it happened,
- apologise, if appropriate, and
- give an assurance as to how lessons have been learned to minimise the chance of this event happening again in the future.”
MPS advocates open disclosure and a full and sincere apology to patients when mistakes have been made, but such discussions must be carried out sensitively and without criticising colleagues
Your hospital will probably have a policy that should be applied in cases where avoidable harm has befallen a patient. It will include guidelines about what sort of incidents should be reported to patients (whether they should be told about so-called “near misses” where no harm resulted, for example) and who should be responsible for explaining it all to the patient.
This will probably be a senior member of the clinical team, but it the job does fall to you we recommend that you talk to a medicolegal adviser at MPS first. MPS advocates open disclosure and a full and sincere apology to patients when mistakes have been made, but such discussions must be carried out sensitively and without criticising colleagues.
Patients expect a great deal from their doctors, not least of which are super human abilities. This means that you are almost certain to disappoint some of your patients some of the time. All you can hope to do in the circumstances is to try and turn negative experiences into positive learning opportunities, thus refining your skills and building, rather than eroding, your confidence.