Being Wrong - Kathryn Schulz [150]
These statistics are disturbing. Almost more troubling, though, is the medical profession’s traditional response to them, which has largely involved evasion, obfuscation, minimization, defensiveness, and denial. This isn’t true of every individual healthcare provider, of course, but it has long characterized the overall ethos within the culture of medicine. In her 2005 book on medical error, After Harm, the bioethicist Nancy Berlinger described the way this ethos is perpetuated. “Observing more senior physicians, students learn that their mentors and supervisors believe in, practice and reward the concealment of errors,” Berlinger wrote. “They learn how to talk about unanticipated outcomes until a ‘mistake’ morphs into a ‘complication.’ Above all, they learn not to tell the patient anything.” She goes on to describe “the depth of physicians’ resistance to disclosure and the lengths to which some will go to justify the habit of nondisclosure—it was only a technical error, things just happen, the patient won’t understand, the patient does not need to know.” In keeping with this assessment, a 2002 survey of doctors’ attitudes found that honest disclosure is “so far from the norm as to be ‘uncommon.’”*
If so, what happened at Beth Israel Deaconess Medical Center was uncommon. The instant the patient drew attention to the mistake, the surgeon realized what had happened, explained it as thoroughly as possible, and—although the act must have felt woefully inadequate—apologized. He then contacted the chief of his department and Paul Levy, the hospital’s CEO, and told them about the situation. Reviewing the case, Levy and other BIDMC higher-ups decided that the mistake was serious enough that both the hospital and the community it served deserved to know what had happened. In very short order, they emailed the entire hospital staff—some 5,000 people—and sent a press release about the incident to local media outlets.
Needless to say, this uncommon reaction didn’t come out of nowhere. In January 2008, six months before the botched surgery, Levy, his board, and his staff made a kind of New Year’s Resolution: by January 1, 2012, they would eliminate all preventable medical harm. Although most hospitals seek to reduce error, BIDMC is one of the very few in the nation to establish such a specific and audacious goal.
Early on in this book, I observed that one of the recurring questions about error is whether it is basically eradicable or basically inevitable. As a philosophical matter, this question is important, since (as I suggested earlier) the way we answer it says a lot about how we feel about being wrong. As a practical matter, it’s clear that the answer lies somewhere in between: many kinds of error can and should be curtailed, very few can be done away with entirely, and some we shouldn’t even want to get rid of. What is both philosophically and practically interesting about this question, however, is the paradox that lurks at its heart: if you want to try to eradicate error, you have to start by assuming that it is inevitable.
The patient-safety initiative at Beth Israel Deaconess Medical Center illustrates this paradox. The first thing the hospital did in pursuit of its goal of eliminating error was to launch a comprehensive investigation of “all the differing ways patients get hurt,” as Kenneth Sands, the senior vice president of healthcare quality, told a Boston Globe reporter at the time. The hospital also began publishing its medical error data publically, on its website, in deliberately frank terms. And hospital administrators committed themselves to, in the words of the initial resolution, “continually monitoring all preventable and non-preventable occurrences of harm.” All this explains why the reaction to the wrong-side surgery was so fast, sweeping, and open. “Our view,” Paul Levy told me, “is that if you don’t acknowledge that mistakes occurred, you’ll never eliminate the likelihood that they’ll occur again.”
Levy’s principle can be generalized. If you really want to be right (or at least improve