Doctors have a very difficult task. After medical school, they face the Herculean task of keeping up with the constantly evolving medical profession. They need to keep up on all the new medications, advanced procedures, new equipment and deal with a mountain of paperwork. They need to translate what a patient says and doesnt say into the correct diagnosis and then formulate an effective treatment strategy.

Its not a wonder that doctors sometimes make a mistake, its a wonder they dont make more of them. Eventually it seems likely that we patients will be confronted by a doctor who has made an error. So what de we do about it?

Dr. Wendy Levinson of the University of Toronto Faculty of Medicine wrote to her colleagues on WebMD Scientific American® Medicine, on January 9, 2004. She asked, What do patients want to know?

A recent study assessed patients attitudes to error disclosure. Patients were unanimous in their desire to be told about any error that caused them harm. Patients believed that such disclosure would enhance their trust in their physicians honesty and would reassure them that they were receiving complete information about their overall care. Patients worried that human nature would lead some physicians to hide or minimize the errors.

In terms of content of disclosure, patients wanted to know what happened, the implications of the error for their health, why it happened, how the problem will be corrected for them, and how the system will learn from the error to prevent it from happening to other patients in the future. Patients also wanted their physicians to apologize.

Apologies are hard for anyone and the doctor faces some very tough questions. Does the doctor tell his peers? His employer? Will the employer be reasonable about it? Was the error serious enough to tell? Will the patient get angry and quit the doctor, or worse, launch a lawsuit?

Dr. Levinson made these recommendations, In your discussion with the patient, at a minimum you should explicitly tell the patient that an error occurred, and you should give a basic description of what happened, why it happened, and what will be done to keep it from happening again. Finally, apologize for the error; although research has not confirmed this, I believe that the patient will appreciate the apology and that an apology may decrease the risk of liability. The Department of Veterans Affairs is engaging in a full-disclosure program; to date, it has not reported an increase in malpractice claims.

What to do depends on the gravity of the error, the relationship between the doctor and patient and how the doctor deals with the error. If its a little thing, a bit of discomfort, a little time lost, then maybe it can be overlooked. We want our doctors to tell us about errors and if we blow up at the little things, they are less likely to tell us about the big ones. If we have known this doctor for some time and built up a trusting relationship, we might consider giving the doctor the benefit of the doubt. Thank him/her for telling us, correct the situation and move on. If the relationship is not solid we have to decide if trading in this physician is worth the risk of getting one who is worse.

If its very serious, then maybe you need to consider taking action by notifying the doctors employer, the insurance company, the medical authorities and, perhaps, an attorney. We dont want to add to the list of frivolous lawsuits that clog the courts and drive up the cost of health care, but if permanent damage is done, a lawsuit is one way of being made whole, as the law describes it. After all, some doctors simply should not be practicing medicine and they need to be encouraged to find other types of work. Whatever you do, start with a clear head and a firm understanding of the facts. Get a second opinion and take the time to consider the matter carefully and completely. When you keep a cool headand have all the factsthe decision should be easier to reach.

Originally published in the February 2004 issue of Recovery.