Nobody’s perfect

For health care professionals, there are few worse moments than the horrible, sinking realization of having made a mistake that harms a patient.

It’s not just the psychic pain that comes with hurting someone whom you intended to help. It’s also worry about the fallout. Will you be blamed? Will you be punished? Will there be an ugly confrontation with the patient and family?

Finally, there’s the lingering self-doubt: Does making a mistake mean you aren’t competent?

It has been extraordinarily difficult for the health care world to admit to being less than perfect, especially when it comes to individual performance. All things considered, this isn’t too surprising. Health care culture has historically been demanding of excellence, and punitive toward those who fall short of the standard.

When you ask patients and families, though, many of them are far more understanding when things go wrong than they’re often given credit for. A recent post at Paul Levy’s “Running a Hospital” blog asks the question: Do patients want to punish? Levy, the CEO at Beth Israel Deaconess Medical Center in Boston, concludes that most of the time the answer is no:

The literature on the topic of disclosure and apology suggests that patients and families are not interested in having the doctor or nurse be punished when a medical error occurs, if (and this is an important if) the clinician makes clear that he or she is clearly regretful about the error, is empathetic with the patient, and if the clinician and hospital show that they plan to learn from the error to help avoid repeats with other patients.

Studies that explore how patients and families respond when something goes wrong with their care are still relatively sparse. To date, though, they’ve been remarkably consistent in their findings: Patients and families don’t necessarily expect health care providers to be perfect. What they really want after an error is accountability. The most recent of these studies appeared just last month in the Annals of Internal Medicine. The authors analyzed data from the University of Michigan Health System before and after the establishment of a program to disclose errors to patients and offer them compensation when appropriate. What they found was that the number of claims and lawsuits went down, as did the hospital’s liability costs. Moreover, claims were resolved more swiftly.

Are patients and families upset and perhaps distraught over being harmed by their care? Of course they are, says Linda Kenney, the founder of Medically Induced Trauma Support Services, a Massachusetts program that educates and supports families and health care professionals who have been involved in a medical injury. All too often, though, there’s a lack of knowledge about how patients and families feel and it can be automatically assumed they’re looking for someone to blame, Kenney writes in a response to Levy on his blog:

We don’t give staff the information about the emotional impact and the stages for the patients/families. If we did, they would know that even if a patient/family doesn’t want punishment, ANGER is a normal part of the healing process. We need to start addressing the impact to staff as well. If they can recognize it in themselves, they will be able to recognize the emotional impact to the patients as well.

Jim Conway, who’s a national leader in patient safety, offers this insight: “Errors don’t necessarily erode trust, it’s the way we act after them that can.”

There is a big difference, of course, between accepting that nobody’s perfect vs. using “nobody’s perfect” as a rationalization for the most careless or reckless of errors. Health care is still struggling with how to achieve a just culture, one that recognizes the role of faulty systems in contributing to error yet holds individuals accountable for their own role in providing safe care. There’s a balance here, and I’m not sure the industry has found it yet.

It all begs the question: When health care providers talk about the expectation of being perfect, are they talking about the public or are they talking about their own expectations of themselves? And when they talk about the need to forgive and to recognize that no one is perfect, who is it, really, who needs to forgive whom?

Photo: Wikimedia Commons