PROFESSIONHonesty is the best policy when discussing medical errorsEthics Forum. Nov. 4, 2002. Scenario: How and when should a doctor inform a patient of a treatment error? A physician mistakenly orders a higher dose of chemotherapy drug than indicated. The overdose causes temporary acute renal failure in the patient. After the patient recovers from the renal complications, he is reluctant to continue chemotherapy and asks the oncologist why he became so sick. How does the oncologist respond? Reply: Our oncologist sits in a very uncomfortable seat that many, if not most, physicians are all too familiar with. To tell or not to tell? If to tell, how much, where, to whom? Did a mistake really happen? How many people and decisions were involved in the mistake spilling through the system and potentially harming the patient? Did the incorrect dose really harm the patient? Will I help or harm the patient by informing him of the mistake? Will I help or harm myself, the nurse or pharmacist involved, or the system I work in by disclosing what I know? Is the patient more likely to sue the hospital or me if I tell him what I think happened, or if I tell him he just had the usual complications? Will the patient be more or less likely to continue his needed chemotherapy if I disclose what I know? If he chooses to sue or go somewhere else for care, will that impact his potential for cure or improvement through unnecessary delay in therapy? Uncertainty around mistakes is common. Fear of disclosure is universal. Let's assume our oncologist has decided to accept responsibility that the mistake was his alone. Our oncologist then must face the frightening questions: What will the patient think of me? What will the nurses think of me? What will my supervisors think of me? What do I think of me?
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