When doctors err

While medical errors are caused by a variety of factors, it’s often doctors who suffer the most when they happen

Mukhtar Ahsan, a diabetic foot patient with a wound, fell and underwent surgery. Tragically, he had pneumonia and repeated heart attacks shortly after, and had to be put on a ventilator. Although doctors from another hospital later said he should not have been put on a ventilator, it was too late. Ahsan passed away, leaving behind a grief stricken family. The family couldn’t help but wonder if the doctors were to blame for this medical error.

Medical mistakes can occur at any point in the treatment process, from diagnosis to the prescription of medications to medical procedure. Doctors, like any other human being, are susceptible to making mistakes. Yet, in medicine, the results could be fatal—a human life.

According to a study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.

Despite the complexity of the healthcare system and the multiple factors that contribute to medical errors, doctors are often the ones who bear the brunt of the blame when things go wrong. But is it fair to blame doctors for medical errors?

“No one should be harmed while receiving healthcare. And yet, globally, at least five patients die every minute because of unsafe care,” said Dr. Tedros Adhanom Ghebreyesus, Director-General at WHO, while addressing the first World Patient Safety Day on September 17 in 2019.

While not all medical errors are the result of negligence or malpractice, it’s clear that errors are a serious issue in healthcare.

Causes of Medical Errors

Technology has played a critical role in mitigating errors in healthcare. For instance, the use of electronic health records (EHRs) has reduced errors in prescription orders and medication administration. While technology has improved, errors can still happen.

In the research paper, “Medical Error,” published in the National Centre for Biotechnology Information, the leading causes of medical errors were identified as communication breakdowns, a lack of standardization, and human factors. The authors outlined how variations in rules and procedures, as well as poor communication between healthcare professionals or between them and patients, might result in errors. Human factors such as fatigue, stress, and inadequate training or experience can also contribute to mistakes.

According to  Dr Arshad Malik, a colorectal surgeon based in Ipswich, England,  one of the major contributing factors to medical errors is the lack of communication and coordination among the various departments involved in patient care. 

For instance, when treating a complex disease like bowel cancer, the patient needs to be managed by a team of specialists from endoscopy, gastrology, radiology, surgery, and oncology, he said. 

“Each stage of the patient’s care is critical, and any misstep could lead to an error,” Dr Malik said.

The Effect on Doctors

Unfortunately, when mistakes occur, someone has to be held accountable, and all too often, that person is the doctor. The high stakes involved in medical care create a culture where errors are often viewed as the result of individual shortcomings rather than systemic issues, which can take a toll on doctors’ mental health.

In the research paper “Culture of Blame—An Ongoing Burden for Doctors and Patient Safety,” published in the National Centre of Biotechnology Information, the researchers argue that the culture of blame creates an environment where doctors are afraid to report errors, leading to underreporting and a lack of accountability. This, in turn, compromises patient safety as errors are not addressed and corrected. The authors point out that the culture of blame harms doctors’ mental health and well-being, leading to burnout and decreased job satisfaction.

Dr Ambreen Qureshi, a resident medical officer (RMO) at the Chest Diseases Hospital in Srinagar recalls being a target of the  furious attendants of a deceased patient  while she was working at a COVID-19-designated hospital. As an RMO, Dr Qureshi was responsible for managing administrative issues, such as ensuring the availability of paramedical staff, oxygen facilities, drug heating arrangements, and logistics. Yet, during the night shift on January 5, 2022, her duty turned into a nightmare when these attendants barged into her room and beat her mercilessly. The patient was suffering from stage 4 cancer, and his attendants wanted to take him home against the doctor’s advice. 

“When the attendants entered my room, I was asking them what had happened, but instead of responding, they started slapping and beating me,” said the Srinagar-based doctor. “They dragged me by my hair, and I screamed for help until the security guards arrived. Despite their arrival, the attendants continued their assault until the police arrived and arrested them.” 

The incident left Dr Qureshi  bruised and swollen, and she could only gather the courage to call her husband for help. 

“I hope this incident serves as a wake-up call to ensure the safety of medical professionals in their workplaces,” she said.

Strategies to Reduce Errors

While it is important to recognize that doctors are not solely responsible for these errors, they still have a critical role to play in preventing them. As a patient, it can be incredibly reassuring to know that your doctor takes responsibility for their actions and is committed to providing the best possible care. 

“With great power comes great responsibility,” said Dr Abdul Wahid Mir, Professor of Surgical Oncology at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), India.

One of the most important steps for a doctor, Dr Mir said,  is to fully explain the diagnosis, evidence-based management, and prognosis to the patient. 

“By discussing the potential complications and outcomes, the patient and their relatives are less likely to be dissatisfied or frustrated with the doctor’s care, which can help prevent harassment or accusations of negligence,” he said. “As an oncosurgeon, I have found that providing detailed preoperative counseling has helped reduce the risk of complications and improve patient outcomes.”

Asked how doctors should deal with medical errors, Dr Mir said that they must remain calm, avoid getting defensive or reactive, and focus on improving their skills and staying informed about the latest research and best practices.

In another research paper “Minimizing medical errors to improve patient safety: An essential mission ahead”, published in the National Centre of Biotechnology Information, the authors argue that a multifaceted approach to minimizing medical errors is necessary and that a focus on patient safety should be at the forefront of all healthcare organizations. The paper proposes solutions such as standardised procedures and protocols, technology-based error detection and prevention systems, and a culture of open communication and continuous learning to reduce medical errors.

Dr Altaf Bukhari, a senior consultant cardiac anesthesiologist at King Fahd Medical City (KFMC) in Saudi Arabia,  called for making efforts to reduce medical errors to the point that it becomes “irrelevant” whether it happens or not. 

“We recognize that medical errors can happen due to systemic issues, such as a lack of proper protocols and procedures,” he said. “To prevent errors, we have implemented safety processes such as checklists and patient identification bands.” 

Dr Bukhari said that the doctors were now actively involving patients in their own care by encouraging them to provide all the necessary details about their medical history.  

“Our goal is to work together with our patients and their families to prioritize safety and reduce the risk of medical errors,” he said. “We believe that every patient deserves the highest quality care, and we are committed to making that a reality.” 

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