Appendix 74b - Accountability

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

A doctor can bury his mistakes but an architect can only advise his client to plant vines - Frank Lloyd Wright

"Most errors are not reported and not discussed," says Harvard researcher L.L. Leape, who worked on studies showing that physicians rarely report even major mistakes. "We have a saying that 'you don't report errors that you can hide...'" Leape said. "Probably less than 5 percent of errors are reported.... And those that are, nothing is done about it."[904]

Professional Courtesy

In one study, house officers discussed the mistake with the patient or the patient's family in less than a quarter of the cases. In a survey of hundreds of physicians more than a third said that they would provide incomplete or misleading information to a family about a mistake they made that led to a patient's death.[905] Advice from the Medical Times, "Doctors should never let 'regret over mistaken judgment' to lure them into admitting a mistake to those who are affected by it."

In "Managing Medical Mistakes" from Social Science and Medicine:

The housestaffers find no role for the patient in monitoring their performance.... The housestaff ultimately sees itself as the sole arbitrator of the mistakes and their adjudication. Housestaffers come to feel that nobody can judge them or their decisions, least of all their patients....

For the housestaff as a group, revealing errors to a patient or to his/her family was not even a... philosophical or practical issue. It was rarely considered among possible options. In response to a question on how mistakes are handled, in only five instances (out of 83 responses) was the patient or family mentioned in any capacity.[906]

When 214 doctors were asked in a 1970 survey about a hypothetical case of a surgeon who'd mistakenly removed a normal kidney instead of the diseased one, how many said they would be willing to testify against him? Less than a third.[907]

Only a physician can commit homicide with impunity - Pliny the Elder

From M. D. Doctors Talk about Themselves, "The best doctor I know once said, 'I don't think you can be a good doctor without being a little bit of a sociopath.' He meant that you have to be willing to blame other people when things go wrong to avoid blaming yourself."[908]

What do residents think should be done if they do kill a patient? From "Managing Medical Mistakes":

Most of the housestaff believed that... a seemingly lenient orientation - no reprimand, no repercussions - was both necessary and sufficient. They strongly asserted that (with few exceptions) it was the only appropriate and justifiable approach to managing errors.... They quickly learn to interpret their behavior as moral and justifiable; they believe that the yoke of responsibility bears heavily on their shoulders, and no one who has not experienced their pressured existence could possibly be a valid judge of their actions.... Doctors, with rare exceptions, are unaccountable for their actions.[909]



[904] Francis, T. "Is This Any Way to Train a Doctor?" Diss. Columbia University School of Journalism, 1997.

[905] Novack, DH, et al. "Physician Attitudes Toward Using Deception to Resolve Difficult Ethical Problems." Journal of the American Medical Association 261(1989):2980-2985.

[906] Mizrahi, T. "Managing Medical Mistakes." Social Science and Medicine 19(1984):135-146.

[907] Cohen, T. "Doctored Lessons." Washington Monthly 1983(February):3, 38-40.

[908] Pekkanen, J. MD: Doctors Talk about Themselves New York: Delacorte Press, 1988:101.

[909] Mizrahi, T. "Managing Medical Mistakes." Social Science and Medicine 19(1984):135-146.



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