A shift away from the "cowboy culture" of medicine is underway, but there's still work to do in preparing clinicians to behave appropriately when things go wrong.
A retired surgeon recently confessed in a newspaper column that he perjured himself to protect a colleague during a medical malpractice trial nearly two decades ago. Lars Aanning, MD, published his column last month and then provided an interview to ProPublica.
Doctor Confesses: I Lied to Protect Colleague in Malpractice Suit
Maybe the most shocking part of his "I lied" bombshell is that it's not so hard to believe.
Doug Wojcieszak, who endured the death of a family member due to medical errors, is well-versed in how ill-prepared physicians have traditionally been when handling medical mistakes.
Wojcieszak founded Sorry Works! in 2005, on the heels of this personal medical malpractice crisis. The organization encourages clinicians to apologize to patients and families after adverse events.
"There is a better way," Wojcieszak wrote in a blog post following Aanning's confession. "It's called disclosure and apology. We're making great progress, but, let's not fool ourselves. Dr. Aanning's column is a stark reminder of the deeply embedded culture we are trying to change."
I recently spoke with Wojcieszak about this issue. The following transcript has been edited.
HLM: This incident occurred nearly 20 years ago. Why is this kind of thing still so prevalent today?
Wojcieszak: I think this type of behavior still occurs, and has occurred for so long, because for clinicians there's an information vacuum for dealing with issues post-event. They haven't been taught what to do when they make a mistake; they're scared.
They're relying on rumors and advice from colleagues who don't know better than they do.
It's like putting a little league team on a field and saying, "We're not going to practice. The kids will figure it out." It doesn't work that way for players or for doctors.
HLM: Physicians are held to such high professional standards. Are they still undermined by the culture of medicine?
Wojcieszak: It's fear of the unknown. Part of our work is to pull the boogeyman out of the closet and debunk the myths.
The idea that physicians will lose insurance coverage if they talk is untrue. Or Aanning's fear that he'd break his employment contract by talking—also untrue.
The other big myth in medicine is that if a doctor gets reported to the National Practitioner Data Bank, his or her career is over. There's a physician shortage in this country.
If I could wave my magic wand, I would have every kid going through medical school, nursing school, dental school, what have you, take a course explaining what will happen when they make a mistake. Not if—when.
The required course would go through everything: what the insurance side would look like, the attorney side, what the patient and family are going through, what the physician goes through as a second victim.
We train physicians up the wazoo on how to get it right—and thank God we do—but we train them very little on how to behave when something goes wrong.
HLM: The perjury in this case was the outer layer of a deeper lie by omission—that the doctor believed his colleague lacked competence. Where are we on addressing that issue?
Wojcieszak: We're seeing a transformation from the traditional, male-dominated, cowboy culture of medicine, in which we don't talk about people's bad behavior and we don't talk to families.
Students coming out of medical school today are just shocked, flabbergasted that there was a time in medicine where it was routine procedure that if there was a mistake, we wouldn't tell the family.
Nonetheless, many of today's healthcare leaders were raised in the old way. They're not going to change overnight. We're going to have to go through a generation or two of not only doctors and nurses changing their mindset, but also attorneys, claims professionals, and administrators.
We're making progress but there's still work to do.
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.