Friday, December 05, 2014

When patients make mistakes

When we talk about medical errors, we usually focus on mistakes made by doctors or the medical staff. However, the truth is that patients often make mistakes as well.

There are many reasons for these mistakes.

Sometimes, patients are confused , because the doctor did not explain things properly . They don’t understand the doctor’s medical jargon, and are scared to cross question the doctor or are reluctant to display their ignorance. They therefore continue to dumbly nod their head, and the doctor is misled into thinking that the patient has understood.

For example, a patient was supposed to take 0.2 ml sc of Lupride, and she ended up taking 2 ml by mistake, because she did not understand what the decimal point meant. Mistakes like this are upsetting and irritating for both patient and doctor. The patient is scared that by taking too much medicine, she may end up causing harm to herself by the overdose; or that she may have to cancel the cycle because she has messed up her medications.

The doctor is irritated, because he feels that he did an excellent job explaining to the patient exactly what to do, and that if she didn’t understand, why didn’t she just ask him for clarification and cross check with him , rather than pretending to understand. Doctors sometimes forget that patients can be quite intimidated by them !

We need to understand that all of us make mistakes , and it’s best to be charitable and understanding – after all, no one goofs up deliberately !  Rather than start assuming that all patients are idiots, these mistakes can actually be great learning opportunities.

The fact is that patients make mistakes much oftener than we realise, and they often cover these up because they are scared that their doctor will get angry and upset , and will shout at them. If you are a good doctor, and the patient has enough confidence in you , she will let you know when she made a mistake , and then it's up to you to resolve it.

Sometimes these are minor issues, which can be safely ignored. However, sometimes these mistakes can create major problems, but these can be tackled only if the patient is willing to confide in her doctor.

Interestingly, sometimes these mistakes can be serendipitous events, which can actually help to advance medical science ! Thus, if the patient takes a lower dose than the one prescribed, and still has a good therapeutic response, the doctor may start prescribing the lower dose to all his patients, because it may be as affective as the standard recommended dose.

This is especially true when patients are taking alternative medicines. They will often hide this information from their doctor, because they are scared he may get upset with them for doing non-standard treatment.  However, if they get better and share this information , the doctor can learn from their experience, if he is willing to keep an open mind. Maybe he can even start advising other patients to try out alternative medicines !

Patient education can play a very important role in reducing the errors which patients make inadvertently, and it's important that doctors and hospitals invest in tools and techniques which help patients to become better informed.

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