Lessons learned the hard way

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The practice of medicine is a great teacher. I admit I have made mistakes; however, I have tried to learn from the errors I have made. In this blog, I will share three stories of blunders and the lessons learned from these errors.

One of my best learning experiences occurred in 1976 when I was a junior resident in urology at Baylor College of Medicine in Houston. I was assigned to a pathology rotation, where my job was to process specimens taken at surgery, dictate a gross description of each specimen, and then place them into the cassettes used to make the permanent sections.

While I was transferring a prostate biopsy, it slipped from the forceps and was washed down the drain of the sink. I took the drain trap apart and searched for the 0.5 mm x 10 mm (1\6 inch by 1\2 inch) sliver of tissue, but I could not locate it. I felt terrible and shared the news with the director of the pathology lab, who recommended that I report what had happened with the biopsy to the urologic surgeon, Dr. Herbert Seybold.

I called Dr. Seybold, and he told me to meet him in the lobby of the hospital at 4 P.M. I worried what would transpire at that meeting. I even imagined that I would be reported to the program chairman and might be asked to leave the program.

Dr. Seybold was in the lobby promptly at 4 p.m., and together, we walked to the business office. He asked for the head of the department and explained what had happened. He wanted to repeat the procedure the following day and asked not to charge the patient for the extra day in the hospital or for the second operating room procedure, as this was a problem caused by the hospital and was not the patient’s fault.

We then went to the operating room and met with the head of anesthesiology whom we asked if the department would not bill the patient for the anesthesia for the second procedure. The anesthesiologist was very sympathetic, and he agreed to waive the additional fee.

Then we went to the patient’s bedside to inform the patient of the event. Dr. Seybold sat down beside the patient and explained that the specimen was lost. He did not blame me but did state that the specimen was lost in the pathology lab. He told the patient that the procedure would be the first case the next day and that he would ask the lab for an expedited reading of the slide. The patient was disappointed but agreed to the plan of action as presented by Dr. Seybold.

Dr. Seybold then took me to one of the private conference rooms and told me that what I had just witnessed was the proper way to handle a complication. He told me that all physicians can expect complications and that mistakes will be made. He said the best way to manage these issues is to be forthright and honest, tell the patients the truth, and accept full responsibility. Patients will understand an honest mistake if the doctor is truthful. It is when doctors make excuses or falsify the facts that patients become angry, hostile, and litigious. Rarely will a patient become a problem if the doctor tells the truth.

I have passed this invaluable lesson on to medical students and residents whom I have mentored over the years. This advice worked well many years ago and is still good today. I believe Dr. Seybold’s message will be helpful to every doctor who is confronted with a problem or a complication.

The rest of the story: What happened to the patient? I accompanied Dr. Seybold to the operating room for the second procedure, hand-carried the tissue sample to the lab, and oh-so-carefully placed it into the appropriate cassette. The final path report was benign, and all three of us — Dr. Seybold, the patient, and I — breathed a sigh of relief.

So, the take-home message of this story is to always tell the truth. There may be consequences for telling the truth, but they will be less than if you withheld the truth and caught in a lie. People will respect you for the truth, and seldom will you burn a bridge for your honesty.

The second story involves a relationship with a pharmaceutical company. I had several conversations with the director of marketing, and he was to get back in touch with me regarding a project. I didn’t hear from the director after sending him multiple letters and emails, including a FedEx letter.

Feeling frustrated by not having a response, I wrote him a letter stating that if I didn’t receive any follow-up, I was going to contact the president of the company and relate my experience and the director’s lack of follow-up.

Shortly thereafter, I received a call from the director’s secretary stating that his wife had terminal breast cancer and that he had taken a leave of absence to care for his wife.

I felt terrible about my overreacting and not knowing all the information about his dire situation. The lesson I learned is to get all the information before coming to a conclusion or before acting. Had the secretary contacted me and told me that the director took a leave of absence for personal circumstances, I would have understood and dropped my request for follow-up. Since that didn’t happen, it taught me to first obtain the necessary information and then act. I should never act without obtaining the reason behind the situation.

Finally, a lesson about putting your foot in your mouth and speaking when you don’t know all of the information.

I was caring for an elderly male patient, and he was accompanied by a much younger woman. When I walked into the room, I introduced myself to the lady and I asked, “Are you his (the patient’s) daughter? She replied with a lovely smile, “No, I am his wife?” Lesson learned: don’t make assumptions. It was not pertinent to know their relationship to care for his medical problem. When in doubt zip it!

Well, I hope these three stories provide some examples of managing a mistake or error and when it is necessary to have more information before speaking or writing. If you have any stories that you would like to share about lessons learned from your patients and your practice, please let me hear from you, doctorwhiz@gmail.com.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.