Practice of medicine or healing is an invasion of human body by definition. Even a medication that can save life of someone has the potential to kill someone else, inadvertently. Every “minimally” invasive surgery procedure to major surgery has the potential of harming a patient either by omission or by commission.
Adverse affects, complications of treatment and surgical procedures are common, according to Institute of Medicine in 1999, 44,000 to 98,000 deaths occurred due to medical errors and according to other estimates, 400,000 deaths a year could be attributed to this. Worldwide medical adverse event could be 43 million!
In the survey of Kaldjian et al, 93 percent of physicians indicated they would disclose medical errors to their patients which is in sharp contradiction to the finding of the same authors that in practice, only 5 percent did so.
The very minting process of the physicians is with Hippocratic Oath, “Do no HARM” which rings in such a contradiction to them causing harm or complication, whether by omission or commission. A physician’s natural reflex in such an event is denial: trying to find a distance to suppress the anxiety, culpability, fallibility, shame and crisis of confidence, all being the results of normal human emotions.
Since complications are inevitable and even the most skilled of the physicians will have complications in the normal course of their practice life and since complications could be unpredictable in many cases, how should they handle it?
A study by Ragenbogen on colorectal surgeons found that complications do change the relationship of patients and surgeons, however, trust remained high among surgeons who had better communication skill.
In my own practice I have found that honesty, humility and treating the patient as a peer human is the best way to deal with the aftermaths of complications. In fact, I turned the communication part upside down by being proactive. Whenever a complication happens or there is a risk of complication as in a “high risk” patient or high risk procedure, I personally call the patient, take the responsibility and explain the rationale to the best of my knowledge and explain them what to be anticipated and how long they are expected in the hospital if they are hospitalized.
I find that in many cases, by paying attention, I can identify “high risk patients” in advance, an example will be a patient undergoing colonoscopy who is on blood thinner for heart condition, or a patient who has many pre-existing medical conditions who needs to undergo a procedure. In these cases, I inform and educate the patient and family in advance as to what could be anticipated in the aftermath and should it ever happen what to do first and then give me a call.
In my own case, after taking this approach, I have been able to form a solid bond and even friendship with my patients who had complications or are at risk of complication. The anticipation part and the advanced education part really help and when and if something occurs, let alone losing trust, patients increase their trust on the physician. In my case, some of my such patients have gone on to become my well wishers and great friends. Some became my teachers and mentors, teaching me other skills of life like ranching, engine repair and animal husbandry. This approach has given me lot more comfort and confidence in my practice. Most of all, it has enriched me as a fallible human, giving me a satisfaction and meaning of life.
Thus, I have turned the fear of medical complication upside down and made it into my friend acknowledging my humility and limited knowledge.
I have failed to keep in contact with you. You have such a good, intelligent and honest heart. Call me for coffee or tea.
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