There is a myth that doctors should be perfect and that a good doctor should never make any mistakes. Medical mistakes remain common despite increasing patient safety measures worldwide. These mistakes can have severe consequences for the patient. It can also have profound effects of guilt and self-doubt on the doctor, as well as litigation.
According to a study at the University of the Witwatersrand (Wits) in 2017, the main barriers to error disclosure in South Africa are fear of victimisation by colleagues and litigation.
None of us like making mistakes, and it can be tempting to try and hide mistakes rather than admitting to them. However, doctors are expected to be honest and open. Researchers found that patients are less likely to pursue legal action when they have received a clear explanation from the doctor following a medical error.
When researchers asked doctors whether error disclosure was the right thing to do, more than 70% of them said yes. Only 16% admitted to openly sharing their last error.
Admitting errors is difficult and will not come naturally. Medical students must be intentionally taught how to face these difficult situations.
In the South African setting, researchers discovered that specialists and postgraduate trainees reported little training in this complex communication skill. In terms of undergraduate students, there was hardly any information regarding training in error disclosure.
Students at the medical school of the University of the Free State (UFS) were asked to review training they had in the disclosure of medical errors. This formed part of a wider study in which medical students reviewed the communication skills training they had received as undergraduates.
The study had a cross-sectional, descriptive and quantitative design. Fourth and fifth-year students completed anonymous questionnaires to review the doctor-patient communication skills training.
The findings showed that almost three-quarters of fourth-year students (73,9%) and considerably more than half of fifth-year students (61,1%) reported that training in error disclosure was infrequent. Almost half of the fourth-year students (49,2%) rated themselves as novices in this skill, while a little over half of fifth-year students (53,3%) rated themselves as average in this skill.
This is an area where there is a huge need and an opportunity for professional growth through learning and teaching.
Medical educators should nurture honesty and humility in medical trainees so that patients can trust medical graduates. Making use of the simulation unit can equip students to become skilled in procedures prior to performing them on patients. Training in patient safety measures such as safe prescribing, good note-keeping and clear interprofessional communication are other aspects of great importance.
System factors that could increase errors, such as insufficient staff to deal with the workload and inadequate resources, should be addressed.
Most importantly, the myth of perfection should be debunked.
) Dr Dirkie Swinfen
is a lecturer and medical officer
in the School of Biomedical Sciences at the UFS
