I am a doctor, I made a mistake and I will not tell you about it …

«Imagine that you devote your entire life to training in a given profession and you could lose it in a second. For most doctors, a profession is also a vocation … The question arises: what next if plan B is plan A ». We look at medical errors, or what doctors fear the most, from three different perspectives.

1. In Poland, there are about 20-30 thousand. medical errors. However, finding a doctor to tell his story proved impossible
2. Maja Herman, a psychiatrist: – Everyone is afraid. And what is most terrifying is not so much the financial penalty as the loss of the right to practice
3. Accused doctors seek help from lawyers, less often – from therapists who would help them cope with stress and guilt
4. You can find more such stories on the TvoiLokony home page

Medical errors – conspiracy of silence

The plan for the article was simple: I will find the doctor who made the medical mistake, talk to him, and then write about his story while keeping him anonymous. I was counting on an emotional confession, guilt, maybe depression. A year later, in a country where, as reported by the Primum Non Nocere Association, there are between 20-30. medical malpractice every year, I still don’t have the main character … I’m looking badly, or maybe my banal concept was a «mission impossible» without Ethan Hunt’s agent from the very beginning?

Brian Goldman spoke about the conspiracy of silence among medics nine years ago in his TED lecture “Doctors Make Mistakes. Can we talk about it? » («Doctors make mistakes. Can we talk about that?»). In his opinion, the panicky fear of fallibility stems from the culture of perfectionism in the medical community. After all, it is not the first person who becomes a doctor, but “top of the top”.

People determined enough to say ‘no’ to the best years of their lives. We eat shakshouka, they eat pancakes from milk bars, we stream “Game of Thrones”, and they use anatomy and biochemistry textbooks. When most of us put on our “corporate warm slippers”, they are still hammering. Our responsibility ends with the project, their lives. Perfection-oriented training must heighten the response to stumbles.

Five years after Goldman’s TED lecture, Dr. Mikhail Varshavski, known as Dr. Mike, “the sexiest doctor in the world”, argued that we really should be afraid of an epidemic of “I Know All” doctors (IKA – I Know All). In his opinion, everyone, especially medics, is licensed to be ignorant. So why do we not give ourselves the right to it in Poland? And where is my hero?

I decided to talk to the psychiatrist Dr. Maja Herman and the lawyers: Małgorzata Hudziak and Joanna Lazer specializing in childbirth errors, as well as Karolina Podsiadły-Gęsikowska representing doctors and medical institutions in disputes with patients. I threw passwords and they commented. This is how the text was created …

So let’s start with the letter P and the word we are all afraid of, i.e. SUMMER …

Maya Herman: Panic fear – everyone is afraid. And what is most terrifying is not so much the financial penalty as the loss of the right to practice, which is not the main goal of the patient. Imagine that you devote your entire life to training in a given profession and you could lose it in a second. For most physicians, a profession is also a calling … The question arises: what next if plan B is plan A. Note that the trend of complaining medics is actually the last decade. Before we get used to the patient’s lawsuit, it will be a good few more years. The more so as there is no subject in medical studies that would teach students about the principles of the legal liability of doctors.

Małgorzata Hudziak: It’s true: doctors just don’t know their rights. They do not know, for example, that they can go to the prosecutor’s office with a lawyer, even when they are questioned as a witness. It is also not always good to refuse to provide explanations once the charges have been brought. The patient expects the doctor to explain why he made the mistake, and the lack of explanation is perceived as a further disregard that dismisses the possible possibility of reconciliation from sight.

Karolina Podsiadły-GęsikowskaThe medics’ complaint trend is indeed on an upward tide. Currently, many cases of medical error are pending before the prosecutor’s office. So we are dealing with a situation where a patient first submits a notification to the prosecutor’s office about a medical malpractice, and when criminal proceedings are instituted, he also submits a civil claim. First of all, because a final conviction, regarding the commission of a crime, binds the court in civil proceedings and may facilitate obtaining compensation from the hospital.

Most notifications to the prosecutor’s office are directed against gynecologists and orthopedic surgeons, and concern the risk of loss of life or serious damage to health and unintentional death. On the other hand, when it comes to civil matters, dentists are most often sued. This is due to the fact that the services they provide are of a commercial nature. Besides, dentists have the tendency that even if they feel uncomfortable or there is a complication for which they are not responsible, they wave their hands and pay for peace and quiet.

Joanna Leisure: Maybe I will say this: there would not be many lawsuits if the doctor-patient communication had not failed earlier. Displacement, falsification of medical records, lack of reflection and the words “I’m sorry” reduce the chances of “P” as an agreement. When the lawsuit arrives in court, it’s not too late to negotiate. Contrary to appearances, the word “sorry” is often more important to the patient than money.

When the postman brings a lawsuit, there is K for CRISIS …

Maya Herman: Everyone survives – if the case is short-lived and the claim is unfounded or you have a predisposition: I can do it, I act, it will be fine, it is better. Otherwise, depression or anxiety disorders may develop. Due to my practice, I divide doctors into specializations that are more and less experienced. The worst case is with double specializations, which I call specializations with a double patient, usually a parent and a child, i.e. obstetric gynecology and paediatrics.

Joanna Leisure: Today, the profession of a gynecologist-obstetrician is a high-risk, also financial one. It is enough to mention that the highest compensation in Poland for a child injured as a result of an error in childbirth was PLN 1,2 million. If we add interest, compensation and a monthly annuity, which can even amount to several thousand zlotys, it is not difficult to imagine how much of a psychological burden the specter of such responsibility must be in further work.

Małgorzata Hudziak: Motivation is also weakening. We know the example of an obstetrician-gynecologist who, after a fatal mistake, stopped believing in himself and no longer wanted to give birth. It was not the community that wrote him off as a doctor, but he himself. It’s sad…

Karolina Podsiadły-Gęsikowska: We all know that you can make a mistake in any profession, but if a doctor makes a mistake, he can get a headache from all sides. He may incur civil liability, professional criminal liability, and the cases are dragging on for a very long time. Imagine 6, 7, 8 years in such a state of suspension. It’s a gigantic stress …

Maya Herman: The problem for today is the attitude of the environment itself, which is not only evaluative, but also unsupportive in crisis moments. I even get the impression that some people get satisfaction when a friend or colleague is against the wall. We are years away from the culture of the medical community in the West.

In times of crisis, we need P, or HELP …

Maya Herman: Medics most often report to my office with panic attacks. Most are helped by psychotherapeutic intervention and a single administration of benzodiazepines, or by emergency psychotherapy, which relieves stress and anxiety, allowing them to return to normal functioning. I would like to point out right away that this also requires a medical certificate and talking about “escaping” is absurd in this case. Believe me: nobody wants to be on sick leave, and if they do, it is also a symptom. It’s easy.

Joanna Leisure: For help, in addition to, of course, a psychologist, it is worth going to a lawyer specializing in medical errors. Denying the problem is not a good advisor, and unfortunately it often happens that the doctor continues in the strategy of enchanting reality until the day of his sentence.

Karolina Podsiadły-Gęsikowska: We also help our clients to go through the liquidation proceedings before the insurer. In most medical malpractice cases, insurance companies refuse to accept civil liability, and the patient takes the case to court. In a situation where we see that the doctor could have been at fault or the case would have dragged on for years, we suggest that the matter be settled amicably, i.e. a settlement. In my experience, however, about 70 percent. claims is unfounded. So why do patients complain to doctors? The problem is caused by compensation offices, which employ lawyers and sales representatives, not specialists, i.e. barristers or legal advisers. Their employees hunt customers and persuade them to file claims.

The time has come for the letter W – GUILT. Why Do Doctors Make Mistakes?

Maya Herman: In my experience, they are rarely under-educated or inexperienced. In many cases, it’s just exhaustion. I remember patients who, a few years ago, chose surgery in the United States for a lot of money. Not because our doctors were worse, but more tired, and in the case of such specialties as surgery or microsurgery, sleep is of colossal importance. Anyway, studies show it: reducing working time from five to four days has a positive effect on our productivity, creativity, relationships with colleagues and work-life balance. And we work ourselves to death and make mistakes that are hard for us to accept. Because perfectionism is deeply rooted in the physician’s psyche – the medics themselves, but also society has labeled us as “superhumans”. Only recently has the younger generation slowly learn that they have the right to have bad days, to go on sick leave, to take a vacation.

Karolina Podsiadły-Gęsikowska: We have a similar theory: making medical mistakes is actually due to flaws in the system. Why do most of the failures occur in hospitals and not in private facilities? Doctors are overworked, which can be seen especially in the era of a pandemic. There is a shortage of human resources, equipment and procedures. Have you ever seen a doctor sit down and drink a cup of coffee? No – they’re really running in these corridors.

Joanna Leisure: Doctors make mistakes because they are only human. Even the best equipment and the advancement of medicine will not help if a human fails. And it fails for a variety of reasons. Sometimes someone is tired and sometimes just plain scruffy. We cannot blame everyone on an imperfect health care system or with staff shortages. If a doctor goes to work on the last fumes or does not update his knowledge, he risks a lot. When asked if it is worth it, he has to answer for himself.

Małgorzata Hudziak: Another situation is when there was no medical error, and yet the patient tries to prove the guilt at all costs and starts all possible procedures. Unfortunately, there are also such patients. We send them back, warning them that they will only incur unnecessary costs and that unjustified claims can break the doctor’s career and personal life. I have once received a phone call from my granddaughter asking how much can be “paid” for the death of my grandfather in the hospital. What and why happened in the hospital was less important for the person concerned.

Maya Herman: There is another factor that we should consider: patient pressure. The patient comes and says: I want, and you can see that he is on the verge of normal. For example, the mother insists on a natural birth, and the fetal weight determined by ultrasound indicates a potential problem. She asks, presses, an inexperienced doctor can succumb. When the situation is black and white, it’s easier for us to say stop. When it is on the verge of normal, we capitulate and medical errors occur. Needless to say, the patient immediately forgets his pressure and the doctor is left alone.

I remember similar situations from the time when I was working in the department. The patient demanded the discharge, he had the right to do so. extract on request. We assessed whether there was a threat to his life or the health and life of other people, we talked with his family and hospital staff. We checked the nursing reports to find out how it functioned. He himself claimed that he had no suicidal thoughts, everything was over and he was healthy. Now imagine that he comes out of the ward and hangs himself on the first tree or throws himself under the train. Error or not error? On the other hand, as I know from the autopsy, you do not discharge the patient, and he complains that you left him in the hospital against his laws and will.

Karolina Podsiadły-Gęsikowska: In Sweden, there is a no-fault system, which we were supposed to follow, i.e. we do not determine the culprit for a medical error, but state that it was committed, pay compensation and think about why the error occurred. Unfortunately, we are going in the opposite direction, tightening the criminal liability of doctors, an example of which is Shield 4.0.

AGAIN W for REMUNDS OF CONSCIOUSNESS …

Maya Herman: You will remember it for the rest of your life. As a young doctor myself, I succumbed to pressure from my family and the patient. The situation was not clear, they wanted to stop taking medications that could be discontinued according to current standards. I did so, and the patient worsened in his illness, which resulted in the need for hospitalization. Today I know that you had to trust your intuition, which said: not yet. I tell my students about this for a simple reason: the more we talk about medical errors, the sooner we get used to them. Because they were, are and will be committed. There is even a saying that a surgeon who does not make mistakes does not operate.

Małgorzata Hudziak: My dad is a doctor. I remember how he discouraged me from taking medicine. He said it was a hard and austerity job. I don’t know if he is completely satisfied now that he knows that I am suing doctors (laughs). However, it is hard to imagine that a doctor who made a mistake would not have remorse and experience a personal tragedy. On the other hand, I have never heard from a client-doctor that he sought psychological help. Perhaps for fear that it would be treated as a sign of a weakness that the culture of perfectionism does not allow itself to do. Or maybe he had taken advantage of it, but he was ashamed to admit it.

How often does R or RECIDIVE occur?

Karolina Podsiadły-Gęsikowska: I can remember one case over the years. There were three claims against a foreign doctor and all of them were justified. Ultimately, in criminal proceedings, he was deprived of the right to practice.

Joanna Leisure: We know the case of a gynecologist who made a mistake twice, but did not admit to either one or the other. Ultimately, he lost both cases. The insurer covered the damage. The doctor is still working in the same place. A small town, no doctors. One would like to say that life goes on, but is it the same?

This is in the end: M for BRAIN. How does the human mind work when it trips?

Maya Herman: How does a child spill salt or spill milk? He covers it, covers it with a cloth, shakes it under the table. It’s an unconditional reflex. What were we taught as a child? Watch out, watch out, beee. And then that feeling of having to be alert, constantly in control, having eyes in the back of your head grows into you and translates into your profession. Yes it works.

This may interest you:

1. Are the forensics doctors who hide the mistakes of other doctors?
2. Medical errors: trials take years, experts are poorly paid
3. A torn head of a newborn, head scarves – what mistakes do Polish doctors make?

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