Case Scenario A patient was latel...

Case Scenario

A patient was lately diagnosed with tuberculosis, and her physician sent her to a public health clinic for treatment. She came to my office for a inferior opinion after a family member, who is a nourish told her that the diagnosis did not make brains A work-up in my office revealed that she had lung cancer.

The patient told her first physician of my diagnosis. His answer was, "I never told you it was tuberculosis, you must have misunderstood me" At our nearest appointment, the patient told me about the physician's answer and that she was unfailing she had not misunderstood his original diagnosis. She had believed it and was ready to start tuberculosis treatment. I was embarrassed because I know the physician personally and occasionally view him at the hospital where we the one and the other have privileges.

to what extent should I handle this situation? The patient did not specifically ask me what she should do about the initial physician's attempted cover-up and did not mention taking legal action against him. In this case, the misdiagnosis was quickly corrected, yet what if it had caused a delay in suitable treatment? Should I confront my colleague about this? If I say nothing to him, for what reason can I face him at our nearest meeting?

Commentary

In the past, physicians had no formal medical ethics training and learned that the best way to deal with medical errors and possible malpractice lawsuits was to say as little as possible, refuse to grant everything, and never to apologize or acknowledge error. Today, physicians receive exceedingly different ethical and legal advice.

Specific to this scenario, the rife physician only has the patient's version of what happened. Physicians should give their colleagues the benefit of the doubt and not assume anything until they have clear, unambiguous evidence. If in fact the original physician had treated the patient as described, the first question is what might have motivated him to attempt to cloak up the error? Is the physician intentionally being malicious, or is he just ashamed or afraid of legal action?

It is generally agreed that patients have a right to know the law about their conditions, including if their physician made errors during evaluation or treatment. (1-3) render free of access disclosure of errors can breed valuable outcomes (e.g., patients receive the information exigencyed to make decisions, physicians frequently can clear their consciences, time to come errors can be reduced).

An American Medical Association (AMA) report (4) upon medical ethics addresses the physician's responsibility to disclose errors, expres belong to for the patient, and make sure ongoing care. The AMA moves giving a general explanation regarding the nature of the error as well as the measures that the physician or office is taking to impede it from occuring again. (4) The report does not distinguish between errors made on physicians themselves and those made by the agency of colleagues. However, the literature forward disclosure of errors committed at others is lacking compared with the burgeoning literature forward disclosing one's own errors.

A textbook in succession medical ethicsm (5) briefly reviews four possible approaches to medical errors: (1) say nothing unles the patient explicitly asks for an opinion; (2) be opposite to the other physician and ask him or her to disclose the error; (3) arrange a joint parley with the patient and the other physician; or (4) own the patient directly, without involving the other physician, about the error. The author of the textbook does not furnish explicit advice and acknowledges that each approach has significant disadvantages. (5)

In this scenario, the patient knows that she was misdiagnosed and that the original physician attempted to veil up his mistake. Therefore, the general physician does not face the difficult decision of whether or not to disclose these facts. However, the issue of for what cause to approach the colleague still remains. The possibility that the patient misunderstood the original physician or misrepresented the situation should be considered. I indicate approaching the colleague and gently bringing up the situation in a nonjudgmental way. This may be the first opportunity for him to discuss the error in a supportive setting. This could lead to considerable relief and comfort and provide an opportunity for him to explain up and to learn for what cause to better handle similar incidents in the that will be If the colleague reacts angrily and set asides the inquiry, the physician may have to distance himself from the colleague in the future

REFERENCES

(1) Hebert PC Levin AV, Robertson G Bioethics for clinicians: 23 Disclosure of medical error. CMAJ 2001; 164:509-13

(2) Wu AW. A major medical error: commentary. Am Fam Physician 2001;63:985-6

(3) Brazeau C Revealing a medication error [Letter reply] Am Fam Physician 2000;62:315

(4) American Medical Association. E-8121 Ethical responsibility to inquiry and prevent error and harm. Accessed online January 18 2006 at: http://www.ama-assn. org/ama/pub/category/11968.html.

(5) look B. Resolving ethical dilemmas: a guide for clinicians. 3rd ed Philadelphia: Lippincott Williams & Wilkins, 2005:218-9