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Message from the MGH

The importance of saying sorry.

Fall 2007
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Medicine has a long history of paternalism, even secrecy, of keeping patients in the dark about details of their diagnosis and treatment—and sometimes about mistakes that occur. Admitting an error, after all, could lead to loss of patient trust, a damaged reputation, job sanctions or a malpractice suit. We now clearly understand that this culture is an obstacle to improvement. When mistakes are made, dissecting what went wrong and sharing that analysis widely is often the best way to prevent an error from happening again.

Meanwhile, patients and families want—indeed, demand—to know everything about their diagnosis and care, and they deserve to understand the details of what is happening to them. We have a moral and ethical imperative to disclose a problem, to communicate fully about the ramifications of a mistake and to apologize. At the same time, we must recognize that although such openness will lead some patients to decide not to sue, others will take it as an open invitation to litigation.

In this issue of Proto we consider the impact of an apology in the aftermath of a medical mistake. We examine how the simple act of saying “I'm sorry” can sometimes prevent litigation as well as bring a degree of emotional reconciliation to a distressing situation. We talk with a family and a patient who have felt firsthand the devastating results of medical errors, and we learn how they have used their experiences to press for changes in the system.

We also consider all of this from the perspective of a second, often forgotten victim: the provider whose error causes harm. Most caregivers hold themselves to an exceedingly high standard, demanding perfection, and when they make a mistake, feel embarrassed, guilty and frightened. Most also feel unprepared to have that difficult conversation in which they disclose their error to a patient and family.

Perfection in health care is unattainable. What may be possible, however, is to create an environment in which caregivers feel they can safely report medical errors and near misses openly and honestly. This information can then be used to guide efforts to improve health care safety for everyone. And safer care clearly is the best we can offer all those who have been harmed by medical mistakes.

Peter L. Slavin, M.D.
Massachusetts General Hospital
David F. Torchiana, M.D.
CEO and Chairman
Massachusetts General Physicians
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