Talking about our mistakes

For internist Bernard Leo Remakus, who has been a rural physician for 25 years, medicine also fuels a second passion: a love for writing. Dr. Remakus is a medical journalist, with numerous articles to his credit, and the author of four books, including a mystery novel with a medical theme (Cassidy's Solution, 1995; 221 East Publishing) and, most recently, Medicine Between the Lines (2004; iUniverse.com).

The following is a condensation of a chapter from another of his books, Medicine From The Heart (2002; iUniverse.com). It is reprinted with the author's permission.

A short time ago, one of my elderly patients underwent what she thought would be routine cataract surgery. Unfortunately, the outcome of the surgery was anything but routine.

The patient and her husband had planned to spend the winter in Arizona following the surgery, and the ophthalmologist told them that there was no reason for them to change their plans. However, appropriate follow-up with an ophthalmologist in that state was not arranged.

Instead, the patient was casually told that she could have her lens replaced by the ophthalmologist of her choice when she arrived in Arizona.

A few months later, the patient underwent a second surgery to have the correct intraocular lens implanted. A few weeks after the surgery, she sustained a massive myocardial infarction, which she attributed to the stress of vision loss and multiple surgical procedures.

Somehow, the patient survived the ordeal, and, upon returning home, she called me to discuss the entire matter.

When the patient and her husband started talking about suing the ophthalmologist for malpractice, I gave them some advice: "If you or your family ever receive medical treatment that results in a less-than-optimal outcome, make the doctor's office the first place you visit to voice your concern."

I did not know the ophthalmologist, but I naturally assumed that any physician would welcome the opportunity to resolve a potential malpractice suit in his own office instead of a courtroom. Consequently, I was greatly surprised when I learned that the ophthalmologist refused to meet with the patient and her husband.

Undaunted by the ophthalmologist's refusal to meet with them, the couple decided to visit his office without an appointment. The unannounced visit caught the ophthalmologist off guard, and answered many of the couple's questions.

According to the patient, the ophthalmologist was defensive and quick to blame the hospital, the lens manufacturer, and even a computer programmer for the surgical blunder. Unfortunately, he was not as quick to offer any apologies or solutions to the problem at hand.

With little alternative, the patient and her husband contacted a lawyer and filed a malpractice suit against the ophthalmologist. A few months later, the parties settled out of court for a sizable amount.

After the settlement, I asked the patient what it would have taken for her not to have sued the ophthalmologist. "Hearing him say that he had made a mistake and that he was sorry," she answered without hesitation.

Newsweek featured an article several years ago that was written by a teacher whose father died from unexpected complications of elective orthopedic surgery. In this article, the teacher talked about forestalling the distant thunder of litigation, and deciding to meet with his father's surgeons to discover the circumstances surrounding his father's death.

The teacher described his father's two orthopedic surgeons not as gods or magicians, but as imperfect and fallible men who were frightened to appear so in a society that expected perfection and infallibility from its doctors. Following their meeting, the teacher felt that the surgeons hadn't been negligent or incompetent, but had merely used the complex and dangerous tools of their craft as carefully as they could.