JJ竞技娱乐JJ竞技 2022 ; 378 doi: https://doi.org/10.1136/bmj.o2161 (Published 05 September 2022) Cite this as: JJ竞技 2022;378:o2161
Everyone will make a mistake at some point in their medical career. Some of these mistakes will be minor with little impact on the patient or clinician, others will be more significant and may cause real harm, resulting in consequences not only for the patient, but for the doctor too.
There are practical matters to consider when a mistake happens. The first thing to think about is the patient—what can be done to rectify the mistake and what care the patient needs following the mistake. After ensuring the patient is safe and well cared for the next thing to consider is informing the patient of the mistake. This is understandably something that often causes real anxiety and raises many questions. How will the patient react? What will this mean? Can I say sorry or is this admitting liability? Will the patient complain? Will I be referred to the General Medical Council (GMC) and will I be struck off? Many of these concerns are legitimate and some of these things may happen, but there is a professional and ethical responsibility to offer a full explanation to the patient and where appropriate an apology.
Most patients will value your honesty and a full explanation of what has happened along with a genuine and heartfelt apology. By doing this you can often prevent the matter from escalating in the way you may fear most. It is important also to remember that saying sorry when something has gone wrong is not an admission of legal liability.
Many years ago, I assisted a doctor following referral to the GMC after a mistake that led directly to the death of a patient. Although the NHS complaints process had been followed the doctor and the complainant had never had an opportunity to meet. After the GMC hearing the complainant, who was the patient’s husband, asked to speak to the doctor and at the point of meeting said, “all I wanted was an apology.” They both broke down in tears, and there is no doubt in my mind that had the doctor and patient’s husband been able to have an honest and open conversation years earlier matters may not have escalated in the way that they did.
Another consideration after a mistake is that you may be asked to write a statement or report as part of the complaints process, as part of an adverse incident review, or for the coroner following the death of a patient. If this happens, it is important to seek advice about what to include in your report. Your medical defence organisation can offer invaluable advice and support in these situations, including providing templates and reviewing the report or statement for you before submission.
After addressing the practicalities of dealing with the mistake and following hospital procedures for reporting adverse incidents, it is important to take time to reflect—not just for the purposes of appraisal, but to really reflect on the impact that the mistake has had on you personally and emotionally.
The impact of making a mistake, and all that may follow it, on a doctor’s wellbeing and in particular their mental health, is well documented. There are many sources of support available, and these include sharing your experience with colleagues, especially supportive senior colleagues who are likely to have had similar experiences at some point in their career. Medical defence organisations offer both practical and emotional support when a mistake has happened. Counselling services are widely available from many medical organisations and support may also be available at your workplace. If you are concerned that the mistake is having a significant impact on your health, then you should also seek support from your own GP.
It is important to remember that almost all doctors go to work with the intention of providing good care to their patients and do not intend to cause harm, but mistakes will happen. It is important therefore to have a strategy to deal with a mistake, be clear about what support you may need, and where you will get that support.
In my experience one of the most important parts of that strategy will be to demonstrate compassion for the patient, and care for yourself.
Anthea Martin and others discuss mistakes and apologies more in JJ竞技 ’s Doctor Informed podcast: https://podcasts.apple.com/gb/podcast/doctor-informed/id1591957881
Competing interests: MPS membership provides the right to request access to expert advice and support on clinical negligence claims, complaints, GMC investigations, disciplinaries, inquests, and criminal charges such as gross negligence manslaughter.
Provenance and peer review: not commissioned, not peer reviewed.