The cost of human error in the medical field

The human cost of medical errors is high. Not only do the patients pay the price of such mistakes, which often lead to complications, iatrogenic injury and even death. Hiding mistakes means you end up carrying a burden of guilt and shame, which can become overpowering with time, especially when compounded by the fact that people often need to lie, hide and cover up mistakes. All of us know what it feels like to make a bad mistake. One tends to feel exposed and scared in case anyone else has noticed your mistake. In such circumstances one can agonize about what to do, whether to tell anyone, and what to say. Later, the event replays itself over and over in ones mind. An individual can event start to question his competence, but fears being discovered. When medical students and junior doctors make mistakes, they are often scolded, ridiculed or punished, which means that we end up being terrified of making mistakes, and often try to do our best to cover them up. This attitude needs to change, and we need to realize that mistakes are an integral part of every learning experience. It is important to provide a structured environment in which these mistakes can be safely made, so patients are not harmed, and there are many ways of doing so safely, for example providing effective supervision. Learning and mistakes go hand in hand, and since all doctors need to be lifelong learners, we will all make mistakes throughout our lives. All humans make mistakes, and doctors are no exception. However, medical errors are far more complex than those that occur in other fields Most doctors are perfectionists, who pride themselves on their professional skills and competence and they feel uncomfortable when these are threatened. The fact that patients pay a heavy price for their mistakes makes it difficult to live with the knowledge that a patient who trusted you and placed his life in your hands may end up losing it because of the doctor’s failure. After making a mistake, doctors’ emotional reactions include; panic, guilt, embarrassment, humiliation, and feelings of inadequacy and isolation. The ability to acknowledge an error is the first and most critical step in the doctor’s healing process, but this is often hard to do. The most effective way for doctors to cope with their emotional reactions after making an error is to discuss such feelings with trusted friends, colleagues or a spouse. However, medical culture, partly because of the fear of malpractice litigation encourages cover-ups of mistakes. Many health professionals prefer to bear the burden of their mistakes in isolation. When an error occurs, most patients would like to be informed about this error and they naturally expect the doctor to provide an explanation or an apology, and to rectify the error. This is what the doctor’s ethical obligation to the patient requires. Most patients who finally end up pursuing litigation usually have multiple complaints including professional failure in diagnosis or treatment, a lack of communication on the part of the health care providers. To prevent mistakes, one needs to be aware of the settings where mistakes are more liable to occur and be even more careful during these high risk times to prevent problems. Circumstances, which increase scope for error include: times you are tired, lazy, or overconfident. Late at night, when you are sleepy, when you are angry, when the patient is irritating and when the patient has a complex medical problem. It’s important to take a proactive approach towards preventing mistakes, and one needs to work on developing systems, policies and protocols to prevent mishaps. I think this should be amongst top strategies by the ministry of health to improve Rwanda’s health care system. In the past, people used not to realize the mistakes of doctors, a strategy that might have been appropriate when doctors had few effective tools in their therapeutic programs and trust in the doctor was a vital element of the healing process. First do and no harm is one of the principles for the doctors but given the prevalence of errors in the medical profession, there should be a lot of efforts to solve these problems earlier than they happen. Perhaps it is because we view most errors as human errors and attribute them to laziness, inattention, and incompetence. Since people often prefer ignoring, overlooking and covering up their mistakes, sometimes they fail to acknowledge them, so they never learn from them. Many experienced doctors as well end up repeatedly making the same mistakes through their lifetime. Also, since they do not discuss their mistakes, they deprive other doctors of the chance to learn from them. It is arguably known that from mistakes, one can learn a lot and the earlier you can make mistakes the better. Often knowing what not to do is more valuable than knowing what to do. There is an urgent need for a structured approach to analyzing critical incidents that allows systematically examining systems and processes rather than falling back on habitual blaming behaviours and biases. Allowing patients to become active partners in their medical care is effective in reducing mistakes. Patients should be encouraged to seek more information and become expert on their own problem. Any one doctor or nurse can make a mistake, but the well informed patient can prevent such errors, by acting as his own last line of defense. Ends