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Difficult Conversations About Errors


Mark A. Hurt MD

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Error: an act involving an unintentional deviation from truth or accuracy ("error." Webster's Third New International Dictionary, Unabridged. Merriam-Webster, 2002. [url="http://unabridged.merriam-webster.com/"]http://unabridged.merriam-webster.com[/url] (14 Oct. 2012)).


How do you approach a colleague when you discover he has made an error in diagnosis? How do you initiate the conversation with a clinician colleague when you have made an error in diagnosis?

These are not small matters as they can have a profound effect on the relationships involved as well as the patient. These kinds of situations should be handled with great respect and with utmost privacy.

The following are some guidelines I have used over the years to aid in resolving such difficult situations.

1. Get the facts. Is the error real? If there were prior biopsies relevant to the case in question, review them.

2. Is the "error" one that has considerable room for interpretation? If so, a telephone conversation should be made to clear up any confusion about the diagnosis, and it is an opportunity to arrange for additional consultations, if necessary.

3. If and when any conversations need to occur, ensure they are done in the privacy of a closed-door face-to-face conversation or privately on the telephone.

4. Attempt to remove moral judgment from the conversation -- stick to the facts. Even if the error is significant, and even if it results in a lawsuit for negligence, it is still an error, and the one who made it should be afforded respect.

5. If necessary, contact the insurance carrier or counsel (or both). Some errors can be fixed; others cannot and will require guidance from those you have hired to help you navigate through the maze of the legal system. Listen to them; they can help you.


Errors are neither pleasant nor desirable, but they are a fact of daily practice. Learning fully about each one, if you become a student of error, will serve to help eliminate them.
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Dr. Phillip McKee

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I am sure that during my career I have made many errors that I am totally unaware of. Often errors are of little consequence when the treatment and prognosis is the same. This is particularly true of many malignant appendage tumors. I did have one case brought to my attention whereby a recurrent focus of melanoma had earlier been misdiagnosed by me as a nevus. When I reviewed the earlier biopsy the correct diagnosis was obvious and I can only assume that I wrote the benign diagnosis on the wrong request form. The lesson is always check that the slide number and form match. With a very heavy workload it is all too easy to miss a mismatch. I went to see the clinican and spoke with him explaining the issue. he was very understanding and spoke with the patient who commented that all phsicians are human and that mistakes were inevitable. There was no litigation. I will always be deeply grateful to the patient for his/her understanding. The recurrence was very small and was re-excised. I have no further follow-up information. Honesty is always the best policy.
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