DOCTORS ARE FALLIBLE!
Posted by bmhegde on 1
In the highly litigious society that we are in today, any mistake committed by doctors is dragged to the courts and the usual yardsticks of justice are applied here as well. By and large, when mistakes occur in medical practice, which is nothing surprising as humans are fallible, the usual practice of doctors is to brush them under the carpet and try to be secretive about their mistakes. This practice has evolved over the years as our present medical education gives the wrong signal to the budding medicos that doctors are Gods and could never make mistakes! They do get an impression, in addition, that the science of medicine is perfect and gives them very solid scientific background to support all their interventions. Every young medical student and doctor thinks that there are perfect algorithms for every intervention or drug administration. This is simply not true. Most medical interventions today fall into the gray area, there being no clear cut black-white demarcation. One should remember that in a dynamic system like the human body, which is continuously run by food and oxygen, linear predictions and linear interventions never work.
Gross negligent errors like amputating the wrong limb or operating on the wrong eye are not to be condoned at any cost as they are plain negligence and deserve punishment. What we are talking about, in the present context, is about the inevitable mistakes that occur due to human error of judgment under trying circumstances of emergency care or other acute situations where clear cut directions could never be obtained from either one’s experience or education. Each patient is different from the next one. No two individuals are alike. All the scientific data in medicine emanate from statistical studies of cohorts (groups) of individuals as patients suffering from a particular malady compared to matched controls of “normals”. We teach students about diseases in great detail not bothering so much about the human being who is suffering, whereas in practice what matters is NOT what disease one is dealing with but WHO has he/she to deal with suffering from that disease. Here lies the foundation of all our mistakes that even the best of us does commit from time to time.
Our greatest test of wisdom comes in the area of time evolution in a dynamic human body of a patient. The linear relationships that we have learnt from the biological sciences of medicine do not apply to patients. The patient behaves in a non-linear fashion always. Doctors, therefore, always predict the unpredictable future of their patients only to get into trouble as time evolves. One could easily be taken to the court on those counts by disgruntled patients aided and abetted by friends and relatives. Due diligence, extra vigilance and proper documentation could avoid most mistakes. Every doctor should aim to avoid mistakes to the extent possible. In the unlikely event of a mistake happening, the doctor should not be ashamed of it and try to hide the truth but should be honest enough to admit the same and explain the circumstances to the patient and relatives in simple language for them to understand and forgive the mistake.
Doctors always enjoy the trust of their patients and if patients are taken into confidence about the inevitable mistake that has occurred, patients normally would stand by their doctors, unless unduly influenced by outsiders. That is where good doctor-patient relationship counts. In addition, a patient who has confidence in his/her doctor is in a better position to get cured as his/her immune system is stimulated to help heal the malady, the so called placebo effect. Medicine, having been taken to the market place by doctors riding on the high horse of technology, attracts market forces to act on the system anyway. One has to be prepared for this kind of litigation these days. A humane doctor always gets the co-operation of his grateful patient even in times of distress. Patients do respect their doctors by and large. In the good old days doctor was a friend, philosopher and guide to his/her patients. A good and sympathetic doctor commands the respect of the patient even today. The patient would always greatly value his/her doctor’s opinion.
For a good healer (doctor) winning over his/her ego is very essential. Doctors’ ego comes in the way of proper healing. Humility is a great virtue. In fact, in the Indian tradition the hall mark of good education is humility. A humble doctor that knows his/her limitations would be a very powerful healer in addition. There are many situations in medical care where conventional wisdom in our system does not seem to help. Under such circumstances one could always look beyond one’s nose and try and get help form so many other sources. There are many complementary systems of medicine where effective treatment strategies are available. A kind doctor is the one who gets to know the fundamentals of all these systems and tries to take the wheat from the chaff in all those systems in case of a dire need for a given patient. This would avoid the patient having to shop around for himself/herself under such circumstances where they have a good chance of falling into the hands of charlatans that masquerade as healers. This results in patients suffering at the end of the day. American medical schools, at least, many of them, insist on a student getting adequate exposure to major complementary systems of medicine.
There are many other ways in which patients could get relief, many of the latter methods have no proper documentation but, they do work at times. One should always have an open mind to try these methods as long they do not entail patients taking medicines internally that had not been tested before. Yoga, tai chi, mediation, breathing exercises, massages, intercessory prayer and, even, shamanic incantations have been shown to work wonders. Rationalists among physicians might scorn at these methods but a well meaning physician would want to explore these methods as well in desperate situations. Absence of evidence should not be construed as evidence of absence. Rationalistic observations are always true but their inferences might not necessarily be right. Passion, at times, makes wonderful observations but might draw wretched conclusions. Never have a closed mind as a physician. One should have the strong foundation of all that one studied in the medical school but should always keep the mind’s doors and windows open for fresh breeze to come in from all sides for the good of patients at large. What man knows today will be proved wrong as time evolves and so an intelligent man does not swear by what he had studied earlier but will be open to suggestions and new information. The doctor, of course, should make his/her own judgment before accepting anything that he has not known earlier to be of use in patient care.
The moral of the story is that humans are fallible even when one becomes a good doctor. Knowing this would make doctors both careful to avoid mistakes that could be avoided and admit those that are inevitable given the circumstances under which doctors work, many times in emergency situations under conditions that are far from being ideal. Honesty and truthfulness helps clear the mist and make patients understand the situation in the right perspective. Doctoring is not a bed of roses where success alone is the goal. Failures are bound to be there. Real success is going from failure to failure without losing one’s enthusiasm, trying not to repeat the same mistake twice. As long as the doctor plays the game well the results matter very little. Doctor must strive to do his/her best although it might not be the best. Science is change and that which does not change is not science. Medical science, therefore, could change but, medical ethics and the fine art of medicine never change. They are for all times to come and they are for the good of the hapless patients in real distress.
Further reading:
1) Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ 2005; 330: 781-83.