A couple of months ago, a post called “Everything’s my fault: How a surgeon says I’m sorry” appeared on KevinMD. It was by a plastic surgeon who feels that no matter what goes wrong with a patient, surgeons should never blame anyone else.
She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to be fed, and a surgeon having to cancel a case because the patient’s blood pressure was elevated. She felt that all of these incidents should be owned by the patient’s surgeon.
I’ve been thinking about this since I read that piece. While I agree that if I order a chest x-ray and find out later it wasn’t done, I would accept the responsibility to have made sure it was done. I have always believed that you should not order a test if you aren’t going to do something with the result.
But if the lab loses a specimen or a patient who was not supposed to eat does so, how is that my fault?
Yes, it is very noble to stand up at a morbidity and mortality conference and say “Everything is my responsibility.” It’s also good roundsmanship because it cuts off further criticism. No one can heap further abuse upon the doctor if she has already admitted fault and accepted responsibility.
But accepting the blame implies that you are going to do something to prevent the error from occurring again.
How does a surgeon prevent a food service worker from putting a tray of food in front of a patient who is NPO? Believe it or not, I used to tell every patient I operated on, “Don’t eat anything after midnight, even if someone brings you food.” Do you think that always worked? The answer is, “No.”
The example of a case being canceled because of an elevated BP is a good example of why a surgeon saying everything is his fault is misguided. At an M&M conference described in the post on KevinMD, this exchange was said to have occurred:
“It’s your responsibility to know the blood pressure in advance,” a senior surgeon called out from the back of the room.
“Of course,” the young surgeon said, with complete sincerity. “Everything is my responsibility.”
And just how did the young surgeon plan to prevent a patient’s BP from going up prior to surgery? It is common for patients to become anxious before an operation, occasionally leading to hypertension. Should he stay at the patient’s bedside overnight? Should he put every pre-op patient in an ICU? How does one stop that sort of event from happening?
Here are some possible scenarios. You tell me if the surgeon should say, “It was my fault. I’m sorry.” If you think it is the surgeon’s fault, tell me how a surgeon can prevent its recurrence.
A nurse gives a surgeon’s patient a medication meant for another patient.
After a CT scan, a patient falls off the gantry in the radiology department.
While drawing routine lab work, a phlebotomist injures a patient’s brachial artery.
Without warning or a previous history of mental illness, a patient jumps out a window.
I’m sorry. Maybe this is my fault, but I just don’t see why in the 21st Century, when medicine is such a team sport, one person should assume responsibility for everything that happens to a patient.
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1300 page views per day, and he has over 8000 followers on Twitter.