Thursday, October 16, 2014
Medical complications torture doctors too
If you are a physician like me who performs procedures, then rarely you will cause a medical complication. This is a reality of medical life. If perforation of the colon with colonoscopy occurs at a rate of 1 in 1,500, and you do 3,000 colonoscopies each year, then you can do the math.
Remember that a complication is a blameless event, in contrast to a negligent act when the physician is culpable. These days, for many reasons, an actual complication is confused or misconstrued as an error.
Some complications are more difficult on physicians than others. For example, if I prescribe a medication and the patient develops a severe rash, I do not feel personally responsible. It’s the drug’s fault. However, when I perforate someone’s colon as a medical complication, I feel responsible even if this act was a blameless event which will occur at a very low but finite rate. (Of course, there are perforations of the colon which result from medical negligence, but I am leaving these aside to make my point here.)
I feel responsible because my hand was on the instrument that caused harm. I can’t as easily blame the scope, as I blamed the rash-causing drug. I’m sure that surgeons feel the same painful emotions when they perform a routine operation and serious bleeding results that requires additional surgery and complicates what should have been an uneventful recovery.
When your hand is on the colonoscope or the scalpel, and the unexpected happens, it’s an awful experience for the doctor even if we have performed according to proper medical standards.
Of course, serious medical complications are much more difficult for the patients and families involved than they are for us. But, we physicians suffer greatly when a patient is harmed from a procedure that we recommend and perform. You can imagine how we torture ourselves with second-guessing when these events occur.
Complications are inevitable. The only gastroenterologist who hasn’t had a perforation of the colon is one who is brand new. So, if you are drawn to a gastroenterologist because he has a 0% perforation rate, caveat emptor! Paradoxically, the most experienced colonoscopists have accumulated many more complications over their career because of a much higher volume of cases or that they are referred very challenging cases by virtue of their skill and experience.
A medical complication is an especially difficult event when it occurs in what was expected to be a routine outpatient examination. Patients who come to our office for a screening colonoscopy understandably expect to be home 2 hours later. So do we. On those rare occasions, when this recovery path is altered, we must have a very serious, sober and unexpected conversation with the patient and the family. Our plan is always to tell the truth and reassure all involved that we will do all that we can to make it right.
Medicine is not a simple or predictable endeavor. Sometimes, it can be rather complicated.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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