'We all kill a few patients as we learn'

[Guest guest]

This is the first time in my life that I have ever heard a doctor admit to

anything. F.

 

http://www.guardian.co.uk/health/story/0,3605,1219003,00.html

 

'We all kill a few patients as we learn'

 

Everybody makes mistakes at work but what if you're a doctor and you ruin a

patient's life - or even end it? Doctor-turned-writer Jed Mercurio recalls a

catalogue of errors from his years as a medical student

 

Tuesday May 18, 2004

The Guardian

 

I made a mistake at work today. We all do it. But what if I said that I was a

doctor? When a plumber gets it badly wrong, he leaves you with a flooded

kitchen; when a doctor gets it badly wrong, he leaves you dead or crippled for

life. One in every 10 hospital patients is harmed by a medical error. As many as

70,000 people die every year as a result of doctors' mistakes.

While I was a medical student, I saw a young guy with a bad knee. After the

patient left, the consultant explained that the surgeon who had carried out the

operation had got it badly wrong, and this was the cause of the patient's

disability. He would never walk properly again. I asked the consultant why no

one had informed the patient. He answered that you don't blow the whistle on

colleagues and they don't on you. I thought that he was wrong, that the patient

had a right to know the truth so he could fight for compensation and that the

doctor should be held accountable for his negligence.

When I qualified, I soon learned that there would be times when I would be

called upon to conduct procedures I had never seen, let alone practised. Airline

pilots learn to fly the plane before they have to carry passengers. Due to

limited training opportunities, doctors gain experience by treating patients. We

are carrying passengers before we know how to fly the plane. Even newly

qualified consultants are under-trained: an average of 8,000 hours' experience,

in contrast to the previous generation who gained 30,000. We all kill a few

patients while we're learning.

I was responsible for a few cock-ups in my early days as a new houseman - a

tardy diagnosis, a wrong infusion, some patients with bruised arms from clumsy

attempts to take blood or insert an IV line - but they were mended by a sincere

apology to the patient and an ad hoc tutorial from a senior colleague. It was a

month before one of us made a contribution to the hospital's mortality rate. A

close friend had been instructed by his consultant to monitor a particular

patient's potassium level, but my friend's shift got wildly busy and he put it

off. The patient suffered a cardiac arrest and died.

He confessed the truth to a couple of us that night, but to his consultant he

claimed that he had carried out a potassium test but that the result had got

lost in the system. He felt awful about the patient's death but he could see no

way of being open about his mistake without his consultant deciding that he was

irredeemably incompetent.

He trusted his fellow housemen with the truth, but he didn't know his consultant

well enough to be sure he wouldn't blow the whistle. I think this was the moment

I realised that not every doctor who makes a mistake is a bad doctor. I knew my

friend was good at his job. He had made an appalling but uncharacteristic error

of judgment. Two years earlier, I had been the moralistic medical student in an

orthopaedics clinic outraged by the covering-up of a young man's botched knee

surgery, and now I was a doctor who understood how many critical decisions cram

the working day and how easy it is for a tragedy to unfold from a momentary

lapse in concentration.

 

 

 

On closer examination, the cases I have cited from first-hand experience don't

reflect the errors of a single individual. The surgeon wasn't the only person

involved in the care of the young man with the wrecked knee; my mate wasn't the

only person looking after the potassium patient. Nearly all medical accidents

result from a chain of errors involving the misjudgments of a series of

practitioners.

The systemic failures with respect to training, supervision, communication and

cross-checking are more far-reaching than the malpractice of an individual.

However, many people find it less disturbing to believe that medical accidents

are due to the negligence of a lone gunman - the individual acting alone and

counter both to his training and to the expectations of his colleagues.

Furthermore, the people harmed by medical accidents are eager - if they aren't,

their lawyers are - to prove negligence, because if they don't, they don't

secure any damages. There are other factors, but I believe these two are the

highest-octane fuel for the blame culture.

The punishments for getting it wrong are only getting harsher. Recently, the

courts levelled a charge of manslaughter against a doctor who injected a drug

wrongly. The same mistake had occurred at least a dozen times before in other

hospitals and by other doctors, all precipitated by administrative blunders and

a lack of safeguards. The system lay at fault, not just the individual. Yet, for

one momentary lapse of judgement while carrying out his normal duties, a

respected professional who has dedicated his life to treating the sick can find

himself facing the same legal proceedings as a knowingly drunk driver who mows

down a pedestrian or a construction manager who with calculation flouts safety

rules to maximise his profits.

Yet when things go wrong, many doctors still feel compelled to admit their

failings. You hope a sincere disclosure will serve as an apology to the patient

and also stop other doctors making the same mistake in future.

I was part of a chain of errors that led to the death of a patient. I believed

my error was the most harmful one - more harmful than the nurses saying the

patient was faking her symptoms, more harmful than the senior doctor who saw the

patient the next day and agreed that we shouldn't do an x-ray or blood tests -

and I confessed it to my consultant.

I was overcome with remorse. I wanted to apologise to the relatives and stand up

at the inquest and say it was all my fault and I deserved to be struck off. He

counselled me to brazen it out. Another colleague helped me buff the notes (to

" buff the notes " is to make entries in the patient's records which don't

actually lie but contain only the helpful elements of the truth). I still feel

huge remorse both for the mistake and for never apologising to the relatives,

but, instead of my career faltering before it had really begun, I learned from

it, became a better doctor because of it, passed on what I had learned about it

to many other colleagues, and I was only able to do those things because my

fellow doctors covered for me.

A couple of years on, I was called to a surgical patient with an abnormal heart

rhythm. A cursory examination of his notes revealed an ECG which showed that he

had suffered a heart attack, but the houseman who had admitted him had missed

the diagnosis. After we had stabilised the patient, I showed the ECG to the

admitting houseman's registrar. The registrar was a mate; he was one of us; I

could trust him. We agreed that he would pretend he had come across the ECG

himself when reviewing the case. He would talk his junior through the lessons to

be learned from the incident. The houseman would never know anyone else was

aware of his error. Not for a moment did I have second thoughts about this

course of action. The system had protected me and I owed a fellow doctor the

same obligation.

Some doctors feel compelled to blow the whistle on their colleagues'

shortcomings. The medical profession invariably ostracises those who broadcast

their concerns to outsiders, on the grounds that outsiders don't know enough

about the job to fairly judge a doctor's performance. In my writing, I have

chosen to concentrate on the darker side of hospital life. You might argue that

I have acted like a sort of whistle-blower, but I feel that I have endeavoured

to acquaint the lay person with the factors that contribute to medical error

and, hopefully, the actions of doctors who close and cover will appear more

understandable.

Turning a blind eye and closing ranks serves well all of us who made the

isolated human error and learned from it and became good doctors. I believe that

is how it served me and my friend who didn't monitor his patient's potassium.

But I have to confess I don't know what kind of doctor the houseman who missed

the heart attack became. It is only then that you realise the system that

covered for you is the same system that wrongly protected GP Harold Shipman and

gynaecologist Rodney Ledward for so many years at so tragic a cost to so many

patients. But, because of the blame culture, many doctors remain persuaded that

closing ranks and covering up are in their interests, because they still fear

that they can be as much victims of medical accidents as their patients.

· Jed Mercurio was a hospital doctor for four years before becoming a full-time

writer. He wrote the successful TV series Cardiac Arrest and his new drama,

Bodies, starts on Sunday at 9pm on BBC3. It will be screened on BBC2 later this

year. His novel, on which it is based, is published by Vintage.

 

 

 

 

 

 

 

Domains - Claim yours for only $14.70/year