Dr. Zorba Paster: Learning about a mistake helps with healing, closure

Having a child is a glorious time, a happy time – that is, when everything goes right with the pregnancy and delivery.

I have lots of patients who keep in touch with me even after they move out of state. One young mom wrote to me about an experience that was very disturbing. She had an emergency cesarean section and almost died.

This woman wasn’t disturbed about the C-section, nor was she upset about the obstetrician’s decision to do the C-section. She was upset about the complications and how the OB handled it.

Apparently, an artery was nicked during the surgery and the woman almost bled out and died. They saved her. They did a good job but they failed in one aspect – they failed to be upfront about the fact they had made a mistake. Those involved never admitted they had mistakenly cut an artery almost leading to her death.

She learned the truth only when she discussed it with a medical malpractice lawyer, who subpoenaed the records. The woman was shocked that this information was in the operative report but never discussed with her.

That was when she seriously considered filing a medical malpractice suit. On one hand, she didn’t want to do this; her OB had saved her life and she liked that doctor. But on the other hand, this woman was very upset that the OB hadn’t come forth and admitted the mistake.

And this bothersome thought came into her mind over and over again because she wants to have another child but wonders what the risks are.

A recent article in Journal of the American Medical Association’s Surgery looked at how surgeons deal with the issue of surgical mistakes. Before I go into the details, I want to put in a good word for all of my surgical colleagues.

They are on the frontlines, and the vast majority are doing a great job, as good as they can. There are outliers but nearly all of them want to excel, and most of them do nearly all the time or they wouldn’t be in this life-and-death career.

But mistakes happen, sometimes through their fault and sometimes through no fault of their own.

Discussing those errors is a very uncomfortable situation. But from a patient point of view, it is paramount.

National guidelines recommend full disclosure when surgical errors happen, but surgeons and, for that matter, other physicians, are not as transparent as they should be.

Most medical schools and residencies do not spend much time on how to do this. We’re trained to treat so many exotic diseases – cholera in Wisconsin? – that the important stuff, like difficult patient communication, falls through the cracks.

A recent study of a Boston health care system looked at 75 surgeons in 12 different specialties, asking them whether they ever admitted to an error and if that admission happened within the first day after it occurred. They asked them whether they expressed regret, whether they expressed concern for the patient’s welfare and if they discussed how this problem might be remedied in the future so it might not occur with someone else.

The result: Only half apologized, only half discussed whether the event was preventable, and only one in three talked about how they might take steps to make sure it wouldn’t happen again.

If I put on my physician hat, I can understand how hard it is to have this difficult conversation. For most doctors, admitting a mistake is harder than telling a patient they have a terminal disease.

From a patient point of view, this is dismal. Learning about a mistake helps with healing and closure. It reduces suffering and can lead to more open discussions.

And, interestingly, from a medical malpractice point of view, a doctor admitting a mistake has been shown to dramatically reduce lawsuits. Many a suit is filed just because the doctor didn’t admit they were wrong, not for the cash payout.

My spin: This is not an easy problem to solve. Physicians need better training to do this skillfully. Stay well.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “Zorba Paster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column appears twice a month in The Spokesman-Review. He can be reached at askzorba@ doctorzorba.com.