Resentment is like drinking poison and then hoping it will kill your enemies. Nelson Mandela
Most patient safety initiatives are focused on preventing medical errors from happening, and this is the right approach. But what do you do if something does go wrong? We’ve provided lots of information on what can be done to stop mistakes, but you also need to know what to do when dealing with a potential medical error:
* How should you expect to be treated by the doctors, nurses, and the hospital?
* How do you find the truth? Is the hospital lying?
* Should you get a lawyer?
* How long will you have to wait to get justice?
While a lawsuit can sometimes be an effective tool, finding true resolution from medical errors often involves more than a fight over money, and sometimes you don’t need litigation to achieve your goals.
Sadly, most people have absolutely no idea what to do after something goes wrong. They often don’t know how to approach the doctor or hospital, how to document events, what they can ask for, or even how to find a good lawyer. Many don’t know the difference between a true medical error and a “complication” or “known risk.”
Was it really an error?
When something goes wrong in a hospital or a clinic, many patients and families automatically think a mistake happened . The jump to the conclusion that the doctor committed malpractice and want to file a lawsuit. These suspicions are compounded when the doctor and nurses abandon you and refuse to talk to you, thus adding insult to injury. However, not every bad result in a medical setting is due to poor care. Medicine has its limitations. Sometimes things don’t work out, despite the best efforts of doctors and nurses.
You first need to find out if the “standard of care” was met or not. Would a competent medical professional, armed with the same set of facts as your doctor, have made the same decisions and choices? If the answer is “yes,” then the bad outcome was likely a “complication” or “known risk”, and not an error. After all, medicine has always been an inherently risky enterprise, and the hopes of benefit have always been linked to the possibility of harm.
About informed consent
Unfortunately, too many patients and families can drive themselves and their surgeons crazy after a bad result, even where there was no error. They’ll forever point fingers and seek revenge with no closure and healing, and too often these people are ignored by the hospital, lawyers, and even their own friends and family. The key to avoiding this situation is to have a frank discussion before the surgery to learn the known risks and complications.
This is called “informed consent,” and it could be the most important discussion of your life. Sadly, most doctors are very casual with this, and patients take the process too lightly. Informed consent has to be more than a piece of paper- it has to be a real, honest discussion where patients, families, and doctors talk about the risks which treatment can pose.
Informed consent = Informed choice. If an injury or death was truly a known complication and nobody’s fault, then the informed consent can help patients, families, and physicians cope with this, and avoid a lot of unnecessary stress and fighting. The point of the consent is to help patients and their families deal with unpleasant surprises in case things don’t go as planned!
A major blow
What happens if your worst nightmare comes true, and your patient has a complication? Learning that a loved one has suffered a serious medical complication can be the worst moment of your life. This can be a gut-wrenching visceral shock, which is so emotionally overwhelming that it can be seared into your memory, and you may experience overwhelming grief, anger, and disbelief.
Never feel embarrassed or awkward for showing the world how you truly feel... this is one of the worst moments of your life and you need help, so ask for it. In the USA, “Medical Induced Trauma Support Services,” MITTS (www.mitss.org) offers support and counseling for patients and families impacted by adverse events. However, it’s NEVER acceptable for you to become violent or to threaten violence. Such behavior closes the doors to possible reconciliation and healing for both sides - the medical staff and the patient’s family. It will most probably just get you thrown out of the hospital and even arrested. Don’t get instigated by “social workers” who can incite you into acting in a way that you might regret later on.
Steps to Take
* First, make sure your patient is safe. Your first concern should be to address the medical needs of your loved one, and this should also be the first priority of the doctors and nurses.
* Learn about the options and what can be done to manage the complications. You are quite likely to have a jaundiced view of the competence of the medical staff after an error. After all, if they goofed once, what’s to stop them from making another mess? It’s quite natural to treat them with suspicion, and you will start wondering if they are being honest, or if they have started a cover-up in order to protect themselves.
** It’s much kinder on your part to assume positive intent – after all, doctors do not want to cause harm to their patients! The deafening silence you may encounter is not because they are conspiring to lie to you , but because of the dysfunctional culture of the hospital staff, most of whom have been taught to clam up. However, if you have lost faith in the doctor or hospital, please ask for a transfer.
* Ask for help with any immediate needs such as food, transportation, financial help and lodging.
* Exchange contact information with your doctor so you are kept in the loop and can keep track of what is happening.
* Write down conversations and keep notes of your observations. Make a journal, and the more detailed it is, the better. Use dates and times where possible in your written notes. * Ask to see the medical records – it is your right. If the staff refuses to give you access to your medical records, escalate the issue. You need to be assertive - after all, why should they want to hide the facts?
* Expect empathy from your doctors and nurses, along with a promise of a review, updates, support and an open door policy.
* However, don’t expect premature apologies or admissions of fault. It’s not fair to push doctors into saying a mistake or error happened.
* The hospital should also get your side of the story by interviewing you. If you have any problems, questions, or concerns, always start the complaint process by returning to your doctor. A doctor will meet you, be empathetic, and initiate a fair review. If the doctor refuses to meet you or is dismissive of your concerns, then you need to meet the higher- ups. Demand to see the manager on duty and the CEO – the hospital owes you openness and transparency.
Should you get a lawyer? This depends. The Indian judicial system can be a mess, and you need to pick your battles. Getting an opinion from a lawyer never hurts. However, do remember that legal battles can be time-consuming and can cause considerable emotional scarring. There are easier alternatives to achieve healing and closure. However, if you have done everything possible to get to the truth, but the doctor and hospital refuse to talk to you, then you shouldn’t feel embarrassed about pursuing a lawsuit.
Sometimes hospitals, insurance companies, and doctors need to be sued in order that they take you seriously. Moreover, there are plenty of stories where apology and appropriate compensation along with emotional remedies-including genuine apologies, have been provided during the litigation process.
Legally, medical negligence or malpractice is defined as ‘lack of reasonable care and skill or willful negligence on the part of a doctor in the treatment of a patient , whereby the health or life of a patient is endangered or damaged’.
If you want to win a lawsuit for negligence, you must be able to establish the following conditions to the satisfaction of the court:
* The doctor (defendant) owed you a duty to conform to a particular standard of medical care
* The doctor was derelict and committed a breach of duty
* You as the patient suffered actual damage
* The doctor’s conduct was the direct/proximate cause of the damage
The burden of establishing all four conditions falls upon the patient, and failure on his part to provide substantive evidence on any one condition may result in no compensation being paid. This is why proving medical negligence can be so difficult. The fundamental requirement for building up a convincing case rests on the availability of medical experts willing to testify on your behalf; and such experts can be difficult to find, because doctors are very reluctant to criticize other doctors.
How can you move on?
The truth is that patients and families want closure and healing and quick resolution after something goes wrong- and so do doctors and nurses. There is nothing worse than having a case hanging over your head and most medical malpractice cases can drag on for several years! But, thankfully, with disclosure and more ethically-minded people working in the healthcare, insurance, and legal worlds, cases are now being resolved quicker to the benefit of everyone.
Sadly, after a medical complication, some patients and families are consumed by their anger by breaking free of resentment. No matter what the circumstances, forgive. The book, Did the Doctor Make A Mistake? By Doug Wojcieszak is a very useful guide.
Be a hero by helping others
Finally, remember that life is not always fair. Consider channeling your grief and emotions in a positive fashion. You can become a “Proactive Survivor”, as described by Trisha Torrey, by transmuting your anger into creating something good for others. You can move from the mindset of being a victim to the mindset of being a hero to others.
Proactive Survivorship gives you choices and helps you learn to cope, and perhaps even thrive, improving your quality of life and others’ lives, too. You can craft your own tragedy- turned-triumph story that shows your strength and ability to move on, and gives hope to others that they, too, can be survivors.
Your personal tragedy may inspire you to create a uniquely Indian platform that allows you to teach others, as you work towards the noble goals of preventing medical errors and improving patient safety. The Empowered Patient Coalition (http://engagedpatients.org/ ) was developed by Helen Haskell who lost her son to bad doctoring and drug errors, and Julia Hallisey who lost her teenage daughter to cancer.
Regina Holliday’s Medical Records Advocacy (http://reginaholliday.blogspot.in) stemmed from the horrible last days of her husband’s illness when they could not get copies of his medical records, leaving him in terrible pain from kidney cancer. Ilene Corina lost her young son to mistakes during his tonsillectomy and has dedicated her life ever since to making sure others stay safe in hospitals by founding Pulse of NY (http://www.pulseofny.org/). By helping others, you may find the closure and healing you deserve.