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Recently in Salon Health & Body

Urge: Naked World
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[11/30/99]

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We met up with my resident in the radiology room and described our failure to extract much fluid. He apologized for not being there with us, but another patient had needed him. Within minutes the technician emerged from the darkroom with our post-procedure X-ray: Indeed, the right lung was just as full of fluid as before. The left lung, however, was clear -- except for six centimeters of plastic tubing. It must have broken off during the procedure.

Even a second-year medical student such as I was could see that not only had I tapped the wrong lung, but I'd also left an irretrievable foreign body inside my patient as testimony to my mistake. I thought I was going to vomit.

As I looked at the X-ray and the startled faces of my superiors, my first thought was "Poor Mrs. Appel." This was silently followed by "I hope this wasn't my fault" and then "We don't have to tell anyone about this, do we?"

Apparently we did. Of course, as a student, I feared for what this would do to my grade. But far scarier than this was that after working so hard and doing so well up to that point, I didn't want the other doctors, whom I truly liked and respected, to end up remembering me for this one, albeit large, blunder. After all, they had respected my medical ability up to this point -- the last thing I wanted to do was risk losing that.

Looking back, I can't honestly remember which was harder: telling frail old Mrs. Appel, exhausted from both her recent procedure and the pneumonia that had caused it, that we had to do it all over again the next day because I had screwed up; or telling my irate attending the same thing. I knew it was only right that the patient be told what had happened. I also knew that I had no choice; my attending would find out later anyway, when he saw the X-ray. Nevertheless, it broke my heart to do both.

It's well-known that mistakes occur in the hospital. Some of these are preventable. Now a newly released study by the Institute of Medicine shows the consequences of these mistakes. Each year, the report claims, between 44,000 and 98,000 hospitalized patients are killed.

One proposal to prevent these gaffes in judgment is to create a Federal Center for Patient Safety. This would involve, among other things, having doctors voluntarily come forward and admit when they make a mistake.

Although I applaud the intentions, I have to wonder whether it's feasible. I just don't know if doctors would come forward. Part of the reason may be because of a "culture of secrecy," which the report says exists behind the walls of hospitals and clinics. But this culture of secrecy is less clandestine than the way it's portrayed -- sometimes we don't air our mistakes because we have already learned from them, and not much can be gained by a formal discussion.

Of course, there is secrecy within any profession. It's no more common to hear lawyers talking at length about their blunders, or investment bankers going on and on about all their miscalculations. But when it happens in medicine, the stakes are higher. These silent mistakes can sometimes be a matter of life and death.

Next page | One resident's honest mistake killed a woman