Doctor means never having to say you're sorry?

My father, like all fathers perhaps, had his list of favorites among his pet peeves.  One of them was about doctors.  "They always say things like, the surgery was a success but the patient died.  If the patient died, how was the surgery a success?"

He often contrasted that with his own profession of civil engineering, where any construction flaw, however small it was, meant that the engineer in charge would be targeted.  Even fired.

Back then--I don't know how it is now--India didn't have a system for suing doctors for malpractice.  At least, nothing that I knew of.  There were atrocious stories-maybe most of them untrue--of physicians and surgeons screwing things up.

In graduate school, I came to an intellectual understanding that errors are always likely in the medical profession.  After all, given the number of variables in the healthy functioning of the human body, a small error can sometimes get amplified into a fatal mistake.

The question then is this: When have you ever heard your doctor tell you that she might have erred?

When my daughter got to medical school, I understood from her more about the “Morbidity and Mortality” meetings that people like Atul Gawande had written about.  The discussions among themselves is different from the conversation with the patient or the patient's family.   Right?

A neurologist writes:

We don’t talk about the emotional trauma of hurting a patient. Instead, most physicians cope with guilt, self-doubt and fear of litigation in private. After our patients, we become “second victims” of our mistakes.

I know I would not be able to function in such a setting.  It ain't easy.

Apologies are difficult for doctors, not only because we have to cope with hurting someone, but also because we are scared of the legal implications of admitting culpability. Early data suggested that apologizing for mistakes decreases malpractice costs, but recent research has called that into question. Although most states have laws preventing medical apologies from being admitted in court proceedings, statements of fault are still admissible in most places. We can say, “I’m sorry this happened,” but not “I’m sorry I did this to you.”

I have often questioned myself on how many lives I have affected through my teaching.  But, my consolation is that the harm that I might have inflicted will be minimal compared to the possibilities in many other professions.  But, there is always that possibility.  I sometimes tell students that--we are not perfect teachers, and that they will have to work with, and through, the imperfections.

Nobody's perfect.