Once a year, I attend the memorial for my aunt, this event is organized by my uncle and his daughters and unlike other other memorial ceremonies, the crowds are growing every year.
This is partly due to the Israeli trend of having three kids per family, as well as the increase in the lifespan of the living. But mostly it’s due to the organization that includes not just standing at the gravesite but a healthy lunch and some cultural nurishment like a visit in a museum, a hike to a historical place or a lecture.
This time there was a lecture by Prof. Avinoam Reches who is an MD and was on the Board of Medical Ethics of Israel. Since I’m interested in both healthcare, Risk and decision making, I took notes.
He talked about the history of medical ethics in Israel, as far as updating the patient regarding her situation. Apparently in the distant past the MD was “allowed” to tell the patient about the diagnosis and the Disease progression, it wasn’t obligatory as it is right now!
This was the time before Dr. Google gave access to medical information, and before we were able to chat with a medical generative AI that holds this data and more.
Then he brought the subject of medical errors and how, in spite of most patients leaving hospitalization in better health, some were damaged during the treatment and some of those damages are not immediate and not known to them. I guess this is a first world parallel to exiting a hospital in China with a suspicious scar near your kidney.
He defined the difference between Error and Mistake:
- Error is generally an unintentional inaccuracy doing the right procedure – Like stitching a wound in a less optimal way.
- A mistake is choosing the wrong procedure instead of the right one, mainly due to some degree of carelessness, inattention, or poor judgment – Like doing vasectomy to a patient instead of varicocelectomy.
Terminology is sometimes confusing in medical errors so an alternative definition is:
- Error of execution is – The failure of a planned execution to be completed as planned, i.e. (Error).
- Error of planning – Choosing the wrong plan to achieve a goal (Mistake).
Errors can be scaled according to severity:
- Slight error – Wrong medication causes a rush that goes away after reporting the side effects.
- Medium error – During hospitalization the medical team forgot to give preventive medication that caused inflammation that needs further treatment.
- Severe error – CT was wrongly interpreted and now there is a high risk cancer with imminent danger to the life of the patient.
Apparently physicians are more likely to report severe side effects as a result of the error than to report on death due to the error. 90% vs. 30% respectively. After all Medical doctors are humans too.
However only 54% reported the error to the resident physician, and only 24% reported the error to the patient family.
This means that there is both a gap in systemic knowledge about the fact that an error was done, and a gap in reporting this error to the stakeholders including the family.
This is primarily due to the culture of Medical malpractice or Medical negligence, legal claims.
Apparently proactive sharing of the facts to the patient, including ones that are not aware of the problem, and suggesting compensation, is reducing the expected damages to the hospitals in several parameters, by reducing hostility, lessening the need for an expensive legal claim and preventing loss of credibility due to public claim.
Since this type of problem is in the domain of welfare economy, some US states defined what is called the “I am sorry law”
Those laws provide a framework that enable the physician to report the error and have the medical institute deal with it thru arbitration process which is less expensive than a Lawsuit and protects from using the results for further legal process.
In Israel, unfortunately a similar law was blocked in the Knesset, by a lobby of Ambulance chasers.
This leads me to think about how democratic process is suboptimal by definition, as mathematically proven in Kenneth J. Arrow. And why we reach extremes in conflicts.
