Taking the blame: appropriate responses to medical error

2018 ◽  
Vol 45 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Daniel W Tigard

Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions—such as guilt, regret and remorse—appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error.

2019 ◽  
Vol 46 (5) ◽  
pp. 339-341
Author(s):  
Elizabeth A Duthie ◽  
Ian C Fischer ◽  
Richard M Frankel

Tigard (2019) suggests that the medical community would benefit from continuing to promote notions of individual responsibility and blame in healthcare settings. In particular, he contends that blame will promote systematic improvement, both on the individual and institutional levels, by increasing the likelihood that the blameworthy party will ‘own up’ to his or her mistake and apologise. While we agree that communicating regret and offering a genuine apology are critical steps to take when addressing patient harm, the idea that medical professionals should continue to ‘take the blame’ for medical errors flies in the face of existing science and threatens to do more harm than good. We contrast Dr Tigard’s approach with the current literature on blame to promote an alternative strategy that may help to create lasting change in the face of unfortunate error.


Author(s):  
Mary I. Gouva

The current chapter examines the psychological implications emerging from medical errors. Whilst the psychological effects have studied, nonetheless the consequent impacts and the underlying psychological causes have not been sufficiently analysed and/ or interpreted. The chapter will add to the literate by using a psychodynamic approach in analysing the psychological impact of medical errors and provide interpretations of the underlying causes. The chapter concludes that medical errors lead to a series of implications. For the patient the quality of interactions with health professionals are directly affected and usually have immediate consequences. The impact of these consequences in the patient is mediated by the patient's personality, history of the individual and the psychoanalytic destiny of the patient. For the patient's relatives medical errors create emotional cracks leading to regression and eventual transference of the medical errors as a “bad” object. For health professionals medical errors impact upon the psychological defence mechanisms of the psychic Ego.


2020 ◽  
Author(s):  
Nadia Febriani br Barus 014

bahwa setiap tindakan medis menyimpan potensi resiko. Banyaknya jenisobat, jenis pemeriksaan dan prosedur, serta jumlah pasien dan staf Rumah Sakit yang cukupbesar terutama untuk tenaga perawat yang memiliki jumlah terbesar dalam jumlahkepegawaian rumah sakit, merupakan hal yang potensial bagi terjadinya kesalahan medis(medical errors). Medical error adalah The failure of a planned action to be completed asintended (i.e., error of execusion) or the use of a wrong plan to achieve an aim (i.e., error ofplanning) (Institute of Medicine,1999:38). Kesalahan medis merupakan sebagai suatu kegagalantindakan medis yang sebelumnya telah direncanakan. Kesalahan yang terjadi dalam prosesasuhan medis ini akan mengakibatkan atau cedera pada pasien, bisa berupa Near Miss atauAdverse Event (Kejadian Tidak Diharapkan/KTD). Tenaga perawat merupakan tenagaprofesional yang berperan penting dalam fungsi rumah sakit. Hal tersebut didasarkan atasjumlah tenaga perawat sebagai porsi terbesar didalam pelayanan rumah sakit. Dalammenjalankan fungsinya, perawat merupakan staf yang memiliki kontak terbanyak denganpasien. Perawat juga merupakan bagian dari suatu tim, yang didalamnya terdapat berbagaiprofesional lain seperti dokter. Luasnya peran perawat memungkinkannya terjadinya risikokesalahan pelayanan. Hal-hal tersebut menempatkan peran perawat sebagai komponenpenting dalam pelaporan kesalahan pelayanan dalam pengembangan program keselamatanpasien di rumah sakit. Oleh karena itu perlu digali berbagai factor yang dapat mempengaruhiperawat dalam melaporkan kesalahan pelayanan. Kesalahan praktek keperawatan dapat terjadi


2019 ◽  
Vol 46 (5) ◽  
pp. 342-344
Author(s):  
Daniel W Tigard

In a critique of my work on ‘taking the blame’ as a response to medical errors, my position on the potential goods of individual responsibility and blame is challenged. It is suggested that medicine is a ‘team sport’ and several rich examples are provided to support the possible harms of practitioner self-blame. Yet, it appears that my critics have misunderstood my demands and to whom they are directed. With this response, I offer several clarifications of my account, as well as a reiteration on the role of self-blame after medical error.


2001 ◽  
Vol 27 (2-3) ◽  
pp. 181-201
Author(s):  
Joan H. Krause

[I]n appropriate instances, the U.S. Attorney's Office will act to investigate and pursue systemic substandard care issues, notwithstanding a provider's representation of compliance with administrative requirements.Medical error and health care fraud are hot topics these days. Since the Fall 1999 publication of the Institute of Medicine (“IOM”) Report,To Err is Human,medical errors have received a great deal of attention in the popular and academic press. Error reporting bills have been introduced at both the state and federal levels, and industry and government representatives have undertaken a variety of cooperative error-reduction efforts.


2020 ◽  
Author(s):  
Maulidya Nabila

Hampir setiap tindakan medis menyimpan potensi resiko. Banyaknya jenis obat, jenis pemeriksaan dan prosedur, serta jumlah pasien dan staf Rumah Sakit yang cukup besar, merupakan hal yang potensial bagi terjadinya kesalahan medis (medical errors).Menurut Institute of Medicine (1999), medical error didefinisikan sebagai: The failure of a planned action to be completed as intended (i.e., error of execusion) or the use of awrong plan to achieve an aim (i.e., error of planning). Artinya kesalahan medis didefinisikan sebagai: suatu Kegagalan tindakan medis yang telah direncanakan untuk diselesaikan tidak seperti yang diharapkan (yaitu., kesalahan tindakan) atau perencanaanyang salah untuk mencapai suatu tujuan (yaitu., kesalahan perencanaan). Kesalahan yangterjadi dalam proses asuhan medis ini akan mengakibatkan atau berpotensimengakibatkan cedera pada pasien, bisa berupa Near Miss atau Adverse Event (KejadianTidak Diharapkan/KTD).Near Miss atau Nyaris Cedera (NC) merupakan suatu kejadian akibat melaksanakan suatu tindakan (commission) atau tidak mengambil tindakan yang seharusnya diambil (omission), yang dapat mencederai pasien, tetapi cedera serius tidak terjadi, karenakeberuntungan (misalnya, pasien terima suatu obat kontra indikasi tetapi tidak timbul reaksi obat), pencegahan (suatu obat dengan overdosis lethal akan diberikan, tetapi staflain mengetahui dan membatalkannya sebelum obat diberikan), dan peringanan (suatu obat dengan overdosis lethal diberikan, diketahui secara dini lalu diberikan antidotenya). Adverse Event atau Kejadian Tidak Diharapkan (KTD) merupakan suatu kejadianyang mengakibatkan cedera yang tidak diharapkan pada pasien karena suatu tindakan (commission) atau tidak mengambil tindakan yang seharusnya diambil (omission), dan bukan karena “underlying disease” atau kondisi pasien.Kesalahan tersebut bisa terjadi dalam tahap diagnostik seperti kesalahan atauketerlambatan diagnosa, tidak menerapkan pemeriksaan yang sesuai, menggunakan cara pemeriksaan yang sudah tidak dipakai atau tidak bertindak atas hasil pemeriksaan atauobservasi; tahap pengobatan seperti kesalahan pada prosedur pengobatan, pelaksanaanterapi, metode penggunaan obat, dan keterlambatan merespon hasil pemeriksaan asuhanyang tidak layak; tahap preventive seperti tidak memberikan terapi provilaktik serta monitor dan follow up yang tidak adekuat; atau pada hal teknis yang lain seperti kegagalan berkomunikasi, kegagalan alat atau system yang lain. Oleh karena itu, diperlukannya peran dari anggota keluarga pasien, sehingga dapat meningkatkan keselamatan pasien di Rumah Sakit .


2015 ◽  
Vol 36 (6) ◽  
pp. 658-663 ◽  
Author(s):  
Greg S. Whiteley ◽  
Chris Derry ◽  
Trevor Glasbey ◽  
Paul Fahey

OBJECTIVETo investigate the reliability of commercial ATP bioluminometers and to document precision and variability measurements using known and quantitated standard materials.METHODSFour commercially branded ATP bioluminometers and their consumables were subjected to a series of controlled studies with quantitated materials in multiple repetitions of dilution series. The individual dilutions were applied directly to ATP swabs. To assess precision and reproducibility, each dilution step was tested in triplicate or quadruplicate and the RLU reading from each test point was recorded. Results across the multiple dilution series were normalized using the coefficient of variation.RESULTSThe results for pure ATP and bacterial ATP from suspensions ofStaphylococcus epidermidisandPseudomonas aeruginosaare presented graphically. The data indicate that precision and reproducibility are poor across all brands tested. Standard deviation was as high as 50% of the mean for all brands, and in the field users are not provided any indication of this level of imprecision.CONCLUSIONSThe variability of commercial ATP bioluminometers and their consumables is unacceptably high with the current technical configuration. The advantage of speed of response is undermined by instrument imprecision expressed in the numerical scale of relative light units (RLU).Infect Control Hosp Epidemiol2015;00(0):1–6


Author(s):  
Patricia McCormick ◽  
Bridget Coleman ◽  
Ian Bates

AbstractBackground Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert.


Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Pat Croskerry

Abstract Medical error is now recognized as one of the leading causes of death in the United States. Of the medical errors, diagnostic failure appears to be the dominant contributor, failing in a significant number of cases, and associated with a high degree of morbidity and mortality. One of the significant contributors to diagnostic failure is the cognitive performance of the provider, how they think and decide about the process of diagnosis. This thinking deficit in clinical reasoning, referred to as a mindware gap, deserves the attention of medical educators. A variety of specific approaches are outlined here that have the potential to close the gap.


PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 243-243
Author(s):  
Gorovitz ◽  
MacIntyre ◽  

At present, the typical patient is systematically encouraged to believe that his physician will not make a mistake, even though what the physician does may not achieve the desired medical objectives, and even though it cannot be denied that some physicians do make mistakes. The encouragement of this inflated belief in the competence of the physician is of course reinforced by the practice of not keeping systematic and accessible records of medical error. Yet everyone knows that this is a false confidence . . . the current high incidence of iatrogenic illness constitutes a medical problem of enormous proportions, well recognized within government agencies and segments of the medical profession, but only dimly suspected by the public at large. There is still a relatively high probability of a patient suffering from medical error. What patients and the public have to learn is to recognize, accept, and respond reasonably to the necessary fallibility of the individual physician. The physician-patient relationship has to be redefined as one in which necessarily mistakes will be made, sometimes culpably, sometimes because of the state of development of the particular medical sciences at issue, and sometimes, inevitably, because of the inherent limitations in the predictive powers of an enterprise that is concerned essentially with the flourishing of particulars, of individuals. The patient and the public therefore must also understand that medical science is committed to the patient's prospering and flourishing, and that the treatment of the patient is itself a part of that science and not a mere application of it.


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