The Black and White Morality Tale

Surgical Mishaps


To the media and public, medical error is only the result of  “negligent” or “bad” doctors. Only careless surgeons leave a metal instrument in a man’s bladder, tearing his bowl… All doctors make mistakes and many live in fear that it will be them pictured under the headline “Incompetent doctor kills patient”. Healthcare is important, we need to make sure that more strain is not placed on hospitals unnecessarily.

We think of it as aberrant behaviour that deserves an explanation, but in fact, mistakes happen all the time behind closed doors. The reason you don’t hear about them should be quite obvious. Hospitals can’t afford to pay sizeable patient claims, so doctors won’t outright tell you “I’m sorry I messed up”. Instead you’ll probably hear “Unfortunately the operation didn’t yield the results we’d hoped for”.

In 1991 the New England Medical Journal published a paper entitled “ (the) Harvard Medical Practise Study” showing how many patients were victims of negligent doctors. Perhaps shockingly only 4% of patients suffered complications resulting in; disability, prolonged hospital stay or death. Of this 4% only 1% could be said to involve negligence on the part of the doctor. To give some scope to the findings, more than thirty thousand hospitals were surveyed. Bare in mind also that this research was conducted almost 25 years ago, hospital procedure and equipment has seen drastic improvement since then. This doesn’t mean that we have achieved perfection quite yet and it’s not reasonable that we expect it, doctors are human after all, but I feel it is reasonable to push the limits of accomplishment and continually strive for better.

“The question isn’t how to keep bad physicians from harming patients, it’s how to keep good physicians from harming patients.”

— Atul Gawande

As noted doctors are humans too. They feel guilt and sometimes lack confidence. I don’t believe malpractice suits which sue hospitals are the correct way to tackle our issues. When convicted, a doctor is almost certain to lose his job, six plus years spent training wasted because of one slip up? Such suits instill fear in the medical community and undoubtedly a pressured doctor is more likely to mess up. What’s more is, cases like these prevent doctors from discussing, or even, acknowledging their errors publically. I think if there were a system in place for colleagues to report their concerns anonymously, you would feel safer as a consequence. They know your doctor’s work best, and can tell if he starts to veer off the rails.

The Morbidity and Mortality conference (M&M), often held weekly, allows hospital staff to meet and discuss what went wrong. It’s purpose is for doctors to acknowledge their mistakes and discuss improvements. You may argue that this instills fear, however an overconfident doctor poses as great a threat as his diffident colleague. Such conferences are favourable additions to hospital procedure, nothing is leaked to the media and so they generate productive discussion. Things go wrong whether admitted publically or not and by addressing the series of failures that resulted in disaster, we can be successful in improving patient care. M&M’s shows doctors recognise that YOU are not a ‘standard model’!

I’ll cite Atul Gawande, “The question isn’t how to keep bad physicians from harming patients, it’s how to keep good physicians from harming patients.” I feel this perfectly sums up the situation. There is in actual fact no black and white morality tale but the media, lawyers and public should cease demanding perfection. I care, because health is important and society needs doctors in order to function. It is human to make mistakes and at the end of the day, doctors are there to help so we should return the respect they deserve.