Mistakes Were Made - Carol Tavris [107]
That longing to hear authorities own up, without weaseling or blowing smoke, underlies the recent movement in the health-care system to encourage doctors and hospitals to admit and correct their mistakes. (We are talking about honest mistakes, human error, not about repeated acts of incompetent malpractice.) Traditionally, of course, most doctors have been adamant in their refusal to admit mistakes in diagnosis, procedure, or treatment on the self-justifying grounds that doing so would encourage malpractice suits. They are wrong. Studies of hospitals across the country have found that patients are actually less likely to sue when doctors admit and apologize for mistakes, and when changes are implemented so that future patients will not be harmed in the same way. “Being assured that it won’t happen again is very important to patients, more so than many caregivers seem to appreciate,” says Lucian Leape, a physician and professor of health policy at the Harvard School of Public Health. “It gives meaning to patients’ suffering.” 5
Doctors’ second self-justification for not disclosing mistakes is that doing so would puncture their aura of infallibility and omniscience, which, they maintain, is essential to their patients’ confidence in them and compliance. They are wrong about this, too. The image of infallibility that many physicians try to cultivate often backfires, coming across as arrogance and even heartlessness. “Why can’t they just tell me the truth, and apologize?” patients and their families lament. In fact, when competent physicians come clean about their mistakes, they are still seen as competent, but also as human beings capable of error. In one of his essays on medicine for the New York Times, physician Richard A. Friedman beautifully summarized the difficulties and benefits of owning up. “Like every doctor,” he began, “I’ve made plenty of mistakes along the way.” In one case, he failed to anticipate a potentially dangerous drug interaction, and his patient ended up in the intensive care unit. (She survived.) “Needless to say, I was distraught about what had happened,” he says. “I wasn’t sure what went wrong, but I felt that it was my fault, so I apologized to the patient and her family. They were shaken and angry, and they quite naturally blamed me and the hospital … but in the end they decided this was an unfortunate but ‘honest’ medical error and took no legal action.” The disclosure of fallibility humanizes doctors and builds trust, Friedman concluded. “In the end, most patients will forgive their doctor for an error of the head, but rarely for one of the heart.” 6
Recipients of an honest admission of error are not the only beneficiaries. When we ourselves are forced to face our own mistakes and take responsibility for them, the result can be an exhilarating, liberating experience. Management consultant Bob Kardon told us about the time he led a seminar at the National Council of Nonprofit Associations’ conference. The seminar was entitled, simply, “Mistakes,” and twenty leaders of the statewide associations attended. Kardon told them that the only ground rules for the session were that participants had to tell about a mistake they had made as a leader, and not to try to clean it up by telling how they had corrected it—or dodged responsibility for it. He did not allow them to justify what they did. “In other words,” he told them, “stay with the mistake”:
As we went around the circle the magnitude of the mistakes burgeoned. By the time we reached the halfway point these executives were copping to major errors, like failing to get a grant request in on time and costing their organization hundreds of thousands of dollars in lost revenue. Participants would often get uncomfortable hanging out there with the mistake, and try to tell a redeeming anecdote about a success or recovery from the mistake. I enforced the ground rules and cut off the face-saving attempt. A half hour into the session