AmyTuteurMD

AmyTuteurMD
Bio
Dr. Amy Tuteur is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School.

JANUARY 1, 2009 1:11PM

Your doctor made a mistake. Do you want to know?

Rate: 7 Flag

I spent a delightful New Years Eve with close friends. All the adults at the party were medical professionals or lawyers and we ended up discussing a thorny medico-legal issue. What should a doctor do when he discovers another doctor’s mistake?

Everyone agreed that when a patient asks a doctor directly (“Did my internist miss my cancer?”), a doctor is legally required to tell the truth. The more difficult question is what to do when a patient doesn’t ask. In that case, there is no medico-legal requirement to point out another doctor’s mistake to a patient, but is there an ethical requirement?

The discussion eventually focused on “what a patient would want to know.” I suggested (okay, I argued) that a patient would want to know the same things that any doctor would want to know in a similar situation. I was surprised by the amount of resistance from the other medical professionals. They insisted, often quite passionately, that telling a patient about a mistake that cannot be fixed will upset her unnecessarily, erode trust in a doctor the patient may be still relying upon, and provide absolutely no benefit.

I still believe that honesty is the best policy. Yet I cannot stop thinking about the passionate defense that others mounted, that a doctor should be committed to a patient’s well being, and that full disclosure might have more harms than benefits. We bandied about the phrase “what a patient would want to know” quite a bit, and it occurred to me that I could ask the question of lots of people by posting it here.

Here’s the scenario that we discussed, a case that actually happened:

A woman was referred to an oncologist for treatment of lung cancer. As is often the case, by the time the patient had symptoms, the disease was quite advanced and the prognosis was poor. The patient had other, unrelated medical issues, and therefore came with a very thick medical chart. Before meeting the patient, the oncologist carefully reviewed her past medical history. After looking through the plethora of previous X-rays and CAT scans, the oncologist made a unfortunate discovery that the lung cancer had been seen on a chest X-ray more than a year before the diagnosis, when it was still quite small and easily treatable. Her personal doctor had simply missed it, a mistake that could not be justified.

After meeting with her, the oncologist concluded that the patient believed her lung cancer was just bad luck. It had not occurred to her that it could have been diagnosed even before she had symptoms. The oncologist pondered what to do. There was no medical benefit to informing the patient: nothing could be done to fix it, and now that she had been referred to an oncologist, her primary doctor would no longer be caring for her. Telling the patient about the mistake would almost certainly cause her additional anguish, which she did not need as she embarked on an arduous course of treatment for her advanced cancer.

Given the circumstances, if you were that patient, would you want to know that your doctor had made a mistake?

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I am stunned that a doctor would even ask this question. Yes, the patient has a right to know. It is her body, and she was trusting every medical professional treating her to do their best by her. Perhaps her primary doctor *was* doing his best, and nevertheless missed the cancer. Not telling the patient doesn't protect *her* as much as it protects that primary doctor, and any doctor not acknowledging this is being disingenuous. The primary doctor must face the consequences of his mistake. The patient has the right to inform anyone she knows of the doctor's mistake. She may; she may not - but it's her decision to make, not the oncologist's.

There is nothing about my health that I don't want to know, and there is nothing about my treatment that I want kept from me, even if there is nothing I can *do* with the information. I want to be treated with respect by the people that treat me; hiding information might seem compassionate, but it is not treating me like a competent individual able to make my own decisions, and I would resent that. A lot.
This is a god question. Is the mistake fatal? In which case I would never know. Or is the mistake going to cost me more time and money?

I want my doc to ask me if I want to know why he kept me waiting in that damn cold room for 45 minutes.
Yes. Knowledge is useful, oftentimes in ways we can't anticipate or don't understand. And we should all know how effective the professionals are from whom we get advice and treatment. Just because something is painful doesn't make it wrong to know the truth.

Unless of course a doctor has specific knowledge about a patient's unusual or temporary inability to handle the info.

And btw, happy New Year! After some the the posts i saw on some of you other posts, i was a little worried about you. Glad you had a good one.
I agree with Sandra.

It seems to me that “not divulging the information” is much more a function of protecting the other physician (or the medical profession in general) than of protecting the patient.

Not to say there are no negative consequences of knowing something like that…but to consider that the primary (or even sufficient) reason for not divulging is, to use Sandra’s kind designation, disingenuous.

I recently had a medical mistake divulged to me…which also involved the misreading of an x-ray. I now have a copy of the x-ray—and I dare say if you saw it, you would have to wonder how a radiologist in a radiology group could possibly miss this.

I wrote a blog on it, which you can find at: http://open.salon.com/content.php?cid=52513
I think the doctor is ethically obligated to tell the patient, and that is the only right thing to do, but I would personally rather not know if I were the patient.
sandra miller:

"There is nothing about my health that I don't want to know, and there is nothing about my treatment that I want kept from me, even if there is nothing I can *do* with the information. I want to be treated with respect by the people that treat me; hiding information might seem compassionate, but it is not treating me like a competent individual able to make my own decisions, and I would resent that. A lot."

That perfectly expresses the way that I feel, too. That's why I was so surprised that anyone would feel differently.
Frank Apisa:

"It seems to me that “not divulging the information” is much more a function of protecting the other physician (or the medical profession in general) than of protecting the patient."

I suspect that it that is often the case, although I could imagine a situation in which a physician didn't care about what happened to the referring physician and was more interested in the patient's well being.

Someone else at the party made a point that I thought was particularly good: There is really no way to protect the patient from the mistake. Particularly in a hospitalized patient, there are so many people involved in her care that sooner or later someone will mention it to the patient without realizing that she didn't already know ("What was your treatment, Mrs. Z, when your lung cancer was originally diagnosed by X-ray?")

At that point, the patient will learn about a multilayered betrayal: everyone knew about the mistake but her.
Erica Andersen:

"I would personally rather not know if I were the patient."

Would you be angry at the person who told you, do you think?
No, I would be very, very angry at the doctor who made the mistake, especially if it was likely to result in my death. I think I'd be happier not knowing, but it is right for the other doctor to tell me about it so that I can complain, tell everyone I know to stay away from the doctor who made the mistake, etc.
I think your friends are willfully ignoring the point that telling the patient is the same as making the information public which is vitally important for the transparency needed for the medical care we receive in this country. What about future patients of the doctor who missed the cancer?
It's happened, and I found out anyway. Crooked doctors and lawyers think that the rest of us are stupid. We find out. Then the crooked doctors and lawyers are shocked! Shocked, I say!

Classic sociopaths.

Most patients these days, especially those of us with chronic and serious illness have access to information that is astounding.

These days, it's about what one can get away with. I cease to call people "professionals" when they cease to be professionals. They become something else.

And trust, respect, and admiration flies out the window. Tell your friends that consequences accrue. Karma kicks butt.
I believe the doctor has an ethical duty to inform the patient or his/her agent, but, like Erica, I'm not certain that, as a patient, I'd want to know.

As a physician or a patient, I'd want to ensure that the erring doc was aware of his or her mistake, and, more importantly, rule out the possibility that the doc had a pattern of errors attributable to incompetence.

What risk is there for the "whistle-blowing" doc, other than possible bad feelings between professionals, or anger from the patient at being the bearer of bad news? In the example you cited, the error seems pretty clear-cut, but is that generally the case? What seems like an error to one doc may seem like a legitimate--if wrong in retrospect--judgment call to another.

When my daughter developed osteomyelitis, requiring two surgeries and causing damage to her joint, it seemed clear (although he never said so directly) that the surgeon was frustrated by the pediatrician's failure to suspect joint sepsis and refer us earlier, which could have improved the outcome. Yet prior to her diagnosis, my daughter had never showed any clear sign of infection--no fever, no redness, little if any swelling, and she had not been ill in the preceding weeks. The only symptom was a limp that didn't resolve over a ten-day period. Did the pediatrician make a clear error? Or was watchful waiting a reasonable course? I wonder what your lawyer pals would say.
OTN:

"I think your friends are willfully ignoring the point that telling the patient is the same as making the information public which is vitally important for the transparency needed for the medical care we receive in this country."

We talked about that, not just letting the public know about specific doctors, but the more general issue of making sure that patients can trust doctors to be honest with them. There is no legal obligation to let the public know, just like there is no legal obligation to report a crime, but that does not mean it is ethical to keep it secret.

The real question in that setting, though, is whether the doctor's ethical obligation to his specific patient (who may be upset by the revelation) is more important than his more general obligation to the public at large.
Squillo:

"Did the pediatrician make a clear error? Or was watchful waiting a reasonable course? I wonder what your lawyer pals would say."

The answers to your questions would probably depend on the standard of care. In failing to make the diagnosis, did the pediatrician ignore classic warning signs of osteomyelitis, in which case he (or she) would be culpable, or was the presentation unusual, in which case it would not be considered the doctors fault if he missed it.
"There is no legal obligation to let the public know, just like there is no legal obligation to report a crime"
If you are aware of a crime and fail to report it you could be charged with aiding and abetting.
I think that only doctors and lawyers would even wonder if the patient should be told. It's a no brainer for everybody else, of course, you're paying for that Doctors work you have a right to all the results. If another Doctor screwed up, at least your family can recover financially.
Which is what this all comes down to really is the attempt to portray the medical system as infallible and thus avoid having to pay for it's manifest foul ups, thus maximizing profits for those in the industry.
If you think people trust Doctors because they are doctors, you're wrong, they trust Doctors because they have no choice. A thousand years ago they trusted the guy who danced in a circle shaking white powder out of a sifter while calling on Amam or Agog (etc,etc) to cast out the evil demons and make them whole. Voodoo didn't often work, but that's equally true of oncology.
I’m on the same bench with those who think the doctor should tell the patient, but if I were the patient, I don’t think I would want to know. I’m afraid that I would wallow for a time in bitterness, and that energy would be better spent on me getting the care I need to get better.

However, ethically, the doctor does need to tell the patient everything related to their care. It is their body, their illness, withholding the information is just wrong.
I think I'm with most of the other folks here. It is positively unethical to withhold information from any patient. Attempting to explain away this ethical lapse by presuming that it would upset a patient is rationalizing for the purpose of protecting one's own interests. If a clear and unequivocal ethical standard existed on this point, both the public health and the medical treatment of individuals would be served.
By the way, Amy…I gave lots of thought to the comment your directed to me in your “Imagine” thread…and offered what I considered a decent response.

Your “comment” had all the appearance of an indictment…an accusation…but I treated it with respect and gave a carefully considered response.

I notice you have posted other things since my response, but you have not responded to it.

I think my response, particularly in light of the way you directed your comment, deserves a response from you.

I’d like you to consider doing so.
1. My life, my right to know.
2. I am just as concerned that the oncologist go to the 1st doc and teach him how to read x-rays, so he isn't a burden to the community.
It's very easy for anyone, even an oncologist, to spot a small lesion through the "retrospectoscope" once you know where to look for it. Did a radiologist review the original film, note the lesion and then the primary doc not read the radiologist's report? Or are you inferring that the radiologist made a mistake by missing it in the reading? They are not infallible, last I heard. But human doctors are still the best we have. Computer aided readings increase the "error rate".
Not telling the patient the truth is akin to infantilizing the patient. How is thinking you're dying because of bad luck better than thinking you're dying because your doctor made a mistake? Not only do I want to know the truth, I want my doctor to inform another doctor when they are wrong, so that it doesn't happen again.

It looks more like a case of protecting one of your own than protecting the patient. I suspect that the patient is angry and the oncologist doesn't want to see that anger directed towards a colleague.
Dragonfly:

"I’m on the same bench with those who think the doctor should tell the patient, but if I were the patient, I don’t think I would want to know. I’m afraid that I would wallow for a time in bitterness, and that energy would be better spent on me getting the care I need to get better."

I guess my friend was right, at least in part. She thought that a lot of people would prefer not to know.
alaska doc:

"Did a radiologist review the original film, note the lesion and then the primary doc not read the radiologist's report?"

No, this was an egregious error. It was read by the radiologist as a cancerous nodule. The primary doctor didn't check the report, for some reason, but there was no expectation that there would be anything like that on the film.

The referring doctor informed the primary doctor, who was horrified. The primary doctor also informed the hospital and the insurance company because of liability issues. No one told the patient. I happen to think that they were all wrong, but a lot of people disagreed with me.
marcelleqb:

"It looks more like a case of protecting one of your own than protecting the patient. I suspect that the patient is angry and the oncologist doesn't want to see that anger directed towards a colleague."

My friend claimed that the patient wasn't angry, but that she certainly would be if she were told the truth. That anger and bitterness would not have been helpful as she faced the grueling treatments ahead of her.

I should also mentioned that the patient eventually died of lung cancer, so there definitely were grounds for a successful malpractice suit.
It's been my experience that anyone who says it's just bad luck is feeling angry, or resentful, or as if they lost out on something, which I don't see as feeling good. They are feeling negative. The doctor probably picked up on this and instinctively didn't want to give that anger fuel.
Do you ever post anything that isn't an attempt to provoke an argument? Can your write us a pensive essay about the view out your window or something?

Of course the oncologist should tell the patient that their primary care physician missed the cancer on the x-ray. And of course most physicians will bury this information if they can.

And not telling the patient their doctor made a mistahe is not an attempt to protect the patient's fragile mental health, any more than soft-pedaling their prognosis would be. It is an effort to protect a member of their own fraternity. Every doctor in the country lives with high practice insurance costs, and most will face at least one malpractice lawsuit in their careers. When faced with this situation, their sympathies will be with the referring physician, unless the malpractice is especially egregious.
As a practicing doc, I review all labs and reports that come back to my office. We have a tickler system for paps and blood tests that we draw in the office. But when I give a patient a form for a mammogram, I have no control if and when she decides to follow thru with that. Most of the time, when she does, I get the report. But occasionally, the clinics where she has the XRay done do not send me a copy of the report. Fortunately, those clinics have now, by federal law, developed their own call back system for times like these.
It drives me nuts when I order pre-op CXRs or EKGs and do not receive copies of them ahead of time, unless my staff repeatedly hounds the techs at the hospital. I do not want a patient to prep for surgery and discover at the last minute that we have to cancel.
Part of the responsibility of the radiologist is now to call, personally, any physician on whose patient something like this is noted. You cannot rely on any system, EMR, FAX, Courier, to deliver this kind of important information. The radiologist rather than just the primary doctor has to bear at least some of the responsibility for failure to communicate in this case, especially if he read it as cancer and didn't bother to contact either the doctor or the patient for follow-up.
alaska doc:

"The radiologist rather than just the primary doctor has to bear at least some of the responsibility for failure to communicate in this case, especially if he read it as cancer and didn't bother to contact either the doctor or the patient for follow-up."

I agree. Unfortunately, incidents like these are likely to become more common as doctors are pressured to care for more patients in less time.
Our Medicare system and its bureaucrats and the politicians who oversee it are to blame for that. They decided to slice reimbursement so thin by saying that doctors can make it up by seeing more patients faster, and that we will know when reimbursement is too low when Medicare patients have trouble getting in to see doctors. AARP supported this decision on the front page of the NYTimes on multiple occasions. Any "system" of health care that monitors its wellbeing on patients getting denied access to care and on increasing patient errors because of overloaded healthcare workers is not a system I care to belong to. More Alaskan doctors have just recently stopped accepting Medicare, to the point where patients are beginning to notice that they can't get in to see a doctor unless they go to the emergency room. I stopped accepting Medicare in 1997 when the original limits were passed and the logic was cruel and clear. I didn't mind doing charity care; I did mind having to pay out of my pocket to pay for my nurses and medical supplies to care for patients who didn't even know they were charity cases. When the decision was to continue to take care of Medicare patients or send my kids to college, I chose to take care of my family.
I believe I have the right to know of the mistake, even if I don't specifically ask,"Did my pcp miss something?" But I usually know why I'm being sent for blood work, or especially something involving an x-ray as part of the procedure, and then I know what to ask when I prepare for my appointment

What truly needs to be tended to, aside from this poor soul's cancer (much sooner that it ever was), is our Medical System as a whole. We need fewer politicians doing doctors' jobs.junk1
Amy, I think this is an excellent post--thought-provoking and intellectual. Your final question wasn't whether we thought it was ethical for doctors to tell or not, it was whether we as patients would want to know. That is a different question entirely and not nearly as obvious as some are making it. For me, the answer is no. I wouldn't ever know about it of course, so that eliminates any negative feelings surrounding not being told. Knowing myself, I would spend endless time and effort feeling bitter. It would ruin everyone's lives around me. No amount of money (if that is in question) could possibly make up for the resentment that would consume me. I am not a sunny, optimistic, move-on-with-my-life kind of gal. The answer for me is NO and your doctor friends were talking about people like me.

That doesn't make it ethical for them not to tell me about it, of course, and that is another question. Thanks for the interesting post.
Lainey:

"Your final question wasn't whether we thought it was ethical for doctors to tell or not, it was whether we as patients would want to know."

That's exactly right. I am actually surprised by how many people wouldn't want to be told.
This query raises an issue that a lot of polls raise - that what people think they want may not be the same as what they actually want.

I would guess that nearly everyone believes they would want to know about any medical error that concerned them. However, this does not mean that they are better off knowing, so the conundrum for the caregiver remains.

So my answer to "would I want to know?" is, like everyone else's, hell yeah. But if I were in the difficult position of being the sole holder of such information, I am not 100% sure I would always disclose it. Let's be honest - we all agree that information should sometimes be withheld if disclosure could cause serious harm; as a simple example, most of us would probably be very careful about delivering extremely shocking news to someone with a dangerous heart problem.

And having said all that... I think the lung cancer example you have given has an easy answer, given that there are probably substantial financial implications in the absence of disclosure, because of apparent negligence.

I also (just to show how random my thinking on all this is) think there's a big picture consideration - we would all be better off if everybody understood that medical mistakes are common, that physicians are fallible human beings, and that every patient should consider their healthcare to be their own responsibility as well as their doctor's. In other words, whatever may happen in individual cases, complete disclosure would be a good thing for the medical system as a whole.
If the physician (you) was not a competent radiologist, why did you have an X-ray machine in their office -- and I would also wonder if you also protected and other pts by the required thickness of concrete wall, or led in the walls and led paint and doors. I really suspect that it would NOT be YOU, it would have been the radiologist who missed the tumor or shadow or who forgot it in his dictation, or the person taking the dictation and typing it up.

LET'S MAKE IT PERSONAL THEN LET'S MAKE IT GENERAL

It's why I have ALL my X-rays taken at the same place every time I have a PA-LAT (front and side view of my lungs) -- the radiologist will put up a series of my PREVIOUS X-rays, slap them on the light table and compare them. The physician was probably following the report that was written by a radiologist -- and expert. Sometimes with and sometimes without the X-ray.

Medicine is SOOOOOOOOOO complicated that no one person can know it all -- as I am a very perfect example. I had throat cancer, saw four docs for a Dx -- all said, after a course of their favorite antibiotic, well it's post nasal drip, hard to cure, will go away when it stops being so cold and windy and drys up in the spring.

My fifth, and current physician said, after two courses of two different antibiotics -- said, "Look, I'm a Family doc -- and an ER doc and I really don't know what I'm seeing down there, so I want to refer you out to an ENT." --- which is what I'd already done when the itching reached my ear. The ENT took one look and said -- "Oh, you have a tumor down there, anyone could have seen it. But don't worry, you are too young for cancer, so it's probably benign, but let's biopsy it anyway." -- and YIPES it was cancer."

When the results came back, it was cancer at 38 or so. Yipes! And I went deaf like everyone, even though I have some medical background -- so I called him back about half an hour after I got home and made an after hours appointment with him so he could tell me again that same day what he'd said in the exam room.

How do I feel about the docs who missed the Cancer which eventually left me with a total larynjectomy -- my larynx (voice box) was completely removed, and now my nose and mouth go ONLY to my stomach and I breath through a hole in my neck. It's normal for me -- the worst part? Honestly: I can't blow my nose. Other than that -- big deal. I forget about it most all of the time, to the point that I will leave my artificial voice at home when going out I feel so normal.

Should I have sued them? Been angry at them? -- why? I've made mistakes in my life -- and laryngeal cancer is around 1% or 2% of all cancers around -- why should I expect my docs, from the beginning to the middle of throat cold and Flu season to pick up on a first sub-clinical (you can't really see it by looking) tumor, and then an inflamed throat with my tumor UNDER my vocal cords with only a very small tip showing and probably covered and only seen by saying 'ahhhhhhh' for as long as I could say it? Hell, it's something **I** may well have missed if it was only 1%- to 2% of all cancers presented and it was winter and I presented with a PMhx of sore throat and hoarseness, now by the second or third physician you think SOMEONE would have picked up on the fact that I had the same complaint and had presented the same for over three months - but they were blinded by the season and we are all blinded by what we see so much of -- it's winter -- this guy has a sore throat and is hoarse. He lectures 15 hours a week probably talks another 10 or more to students at his work -- maybe more -- no WONDER his throat is sore swollen and hoarse -- and he never takes a day off -- and it's been awhile so it may be a secondary bacterial infection caused by the original viral infection -- so here take these for two weeks and I call for an other appointment and the orders are that I take the same med for two more weeks -- just to be sure -- and I go in and hear 'post nasal drip' and think it's time for a second opinion - only my throat is getting worse and worse -- perhaps changing Docs was the problem -- but finally one said take course A antibiotics for a week, Didn't get better, OK then, take course B for two weeks, then he says, well hell, I don't know -- why don't you go see a specialist? The specialist says, "Well hell, ANYONE could have seen you have a tumor." Well, sure, if you are looking down someones throat 8 hours a day for 20 years they could have.

Did it do me any good to know that my other docs missed the tumor -- nope-- only that they need to read their charts more carefully -- and look at dates -- OH -- so you were here FOUR weeks ago -- not simply, "Oh last time I saw him it was a sore throat -- well, it's probably hard to clear up-- a back of the sinuses infection that's hard to clear up, but as soon as he stops producing mucous, it will dry up and go away." -- not a bad Dx. It' generally not life threatening, or I'd present with different symptoms.

So, I see my doc now because he can say 'I don't know' -- let's find the REAL cause -- because he, too, mentioned how difficult it can be to clear up some post nasal infections -- but let's find out -- he was curious -- cool.

Should he have turned in all the other docs to BMQA -- board of medical quality assurance (and pronounced 'BUM-qua') -- and could I have gotten a VERY large settlement from ALL the Docs who looked at me and told me to never mind it would go away? And never, ever, ever, ever, worked another day in my life?

Sure -- no doubt about it -- I could have lost my job, lived my live as a 'cripple' and 'handicapped' -- but I taught for another almost 20 years before I retired. It didn't slow me down much at all. Teaching was too much fun -- why quit?

EVERYONE MAKES MISTAKES. EVEN DOCTORS AND LAWYERS!!! ---

WHY did the discussion land on Doctors? Why not Lawyers? Can't lawyers make mistakes?

OK: It's a Friday, you have had a back-to-back string of pts the weekend is coming up, and it's like Monday, everyone wants to see you before the two days they can't and you are over booked so you can mainly reassure your pts that it's OK, don't worry, make an appointment sometime in the next week or two 10 minutes talking and exam at most -- you are coming down with a cold -- you are just burnt out -- a pt presents just like very other pt -- Ok just another one with the same symptoms -- Ok open your mouth -- Say AHHHHHHH -- um, its red, swollen hoarse, you see mucous, you see vocal cords swollen -- now that can have a gazillion causes -- you know I teach at the college so it's probably 90%-95% just irritation of lecturing 15 hours a week and taking to students and you've heard me say that I hate this semester, I have to lecture from 8:00 AM-12:30 PM non-stop on Tuesday and Thursday -- I don't take sick leave, heck, I'm in my late 30's -- why would ANYONE suspect cancer?

Really -- why would ANYONE suspect cancer that hit's 60+ year olds in a late 30's pt who can't tell you he's served in 'Nam, and even then, Agent Orange was not recognized as a cause of cancer, though there was beginning to be a mountain of evidence -- So it's a cold or the flu -- go home drink liquids, take some antibiotics, and see if it clears up.

===========================
THE CASE IN QUESTION
===========================

"First do no harm . . ." -- would it do your patient any good to know that they MIGHT have had a 90% chance of 'cure' (you guys,. a 'cure' is only 5 years cancer free, it doesn't mean much more than that). Again not much info on pt -- smoker? drinker? diet? Life style? -- but let's just assume it WOULD have cured it -- would it do your patient any good at all to know that she could have been saved? Or would it only cause emotional pain and stress and distress -- and sorrow and pity . . .?

OR ARE WE TALKING ABOUT MONEY? -- there is a difference between getting money from a doctor or physician so is it about telling your physician that a radiologist make a mistake somewhere? Or is it about MONEY?

MY Physicians go by the radiologist's reports -- Now one of them can do a digital up-load of images from the hospital that they can look at on their computers, but they are really just looking to confirm the Radiologists reports -- and they are probably NOT looking for something they missed AND they are probably not going to upload an image when they have a radiologists report that says 'clear' -- the other physician can't up-load my x-rays from the hospital. So all he has to go from is what another doc said. A specialist. Who would you trust - the specialist, or your family doc who said go see a specialist?

Now the real question: is there really a 'normal' patient -- or are we all different? --- Me? You already know that even losing my voice is the mistake of other doctors -- and it was 1/6 of the ones I saw, and I was running out of local Docs to check me -- so I referred myself -- after all, I was going more and more hoarse and it takes not days, but weeks or longer to bring back a voice from vocal cords which may have scarred themselves, and is it fair to the stuents to lose that part of me that allowed me to talk to them?

And when I found out I had cancer -- yipes - it was the way I made my living!!! Sure I could have been angry at a lot of people, because I'd live and be able to exact a revenge over time if I let anger and chaos rule my life! But I let it be, it was a new life, a time to learn a whole bunch of new stuff -- and learning is not always pleasant, but it's always fun!

I have made many mistakes in my life, and I talked to all the other docs, so now they know they blew it -- but **I** did it -- because I wanted them to know that I was not angry, I held no professional malice towards them -- but just wanted to remind them that maybe it's a good idea to follow a chart-- and preempt the pt from making another appointment with another doc -- Some pts. would go red with furry and anguish -- the first phone call they would make is to a Lawyer -- who don't make mistakes I guess --

Here is what a very wise man once told me: We have to give to others the same rights and freedoms we want for ourselves.

I like the right and the freedom to be wrong -- and mistaken -- and if I get sloppy, a simple phone call or talk from a fellow close cohort would go a VERY long way. Some people take a word of reprimand to correct, others take a 2x4 up side the head -- I'm the former, and I believe that MOST others are the same (surgeons excepted).

I have a clause in my will that says that any physician I choose can NEVER be charged with ANYTHING -- EVER. Now the radiologist was not of my choosing, he was hospital staff can I sue him without suing MY physician? Probably not -- and does he have the right to make a mistake? sure. Just like I do.

Friendly Fire mistakes happen all the time -- I'd feel bad if I shot a buddy -- or someone on 'our' side - just like they'd feel bad if they shot me. Put them in prison for a mistake in a firefight? Like someone said -- a firefight is like nothing else you can even imagine unless you have been there done that -- and I would say it's scarier than the lowest level of hell -- And EVERYONE is suppose to stay absolutely sane and focused with whizzes and thumps and thunks and wingggggggs and sometimes the feel of heat between your neck and shoulder and maybe a scream all around them all at once? Doesn't happen. Ever. Mistakes are made -- It's why you always train in slow motion -- very slow motion --- because when you need the skills -- you speed up so much either you speed up with skill, or you get clumsy and scatted, and sometimes freeze, and sometimes wounded or killed because when you went from 1/4 times normal to 10 times faster than fast-normal in about two seconds you go kind of crazy.

The perfect doctor? Doesn't happen. If you have doubts -- get another doctor -- find a physician. And even a physician makes mistakes. Do I want to KNOW that another doc made a mistake? Only if it's one I've chosen -- and I tell all of this to my physician every time I see them for the first few times -- because, there is always the chance that the second physician made a mistake too.

So let B check A and A check B. And let ME tell the Doc who blew it. -- but then I was a Corpsman and a paramedic and I can talk freely and without rancor to a physician, and a mistake doesn't bother me. My parents were also physicians -- with VERY low insurance rates, a shrink (father), and an RN with PhD in Public Health and and MD. Not exactly real clinical office visit work. And lots of wiggle room if you make a mistake. So I know people make mistakes -- Dad did, Mom did, I did. And we were all 'Professionals' -- and these days the corpsman comes back and with a class or two is an RN. Back then it didn't happen, it was start as a freshman. But I COULD transfer with hospital certification to Paramedic which I did -- easy -- exact same work, only different.

Medicine is, like teaching, it's an art and not a true science -- there are many shades of blue and reds and grays and white -- when does white turn gray? When does gray turn white? -- telling the exact shade and color changes through the angle of the sun and with your mood. And the exact shade is important. So mistakes get made. Remember X-rays are white and black and gray. With shadows.

I've blown it with students, and I lost my voice because of several doctors all saying and thinking the same thing -- and only one thought to send me out and not assume my profession plus my symptoms equaled my presentation.

So I say: First do no harm . . . If it's a continual problem from a specific doc -- then BMQA can handle it --- and most Doc's are, as Amy pointed out by mentioning that most at her party were docs, medical professionals, friends -- and a discreet call from one to the other can sure help pin down a quack. HIPPA or not.

So I vote NO IN GENERAL, yes if you know your patient very well AND know it will do no greater harm. Here, let me say - I am not one who believes everything stops at death, so what some call death, many of us call growth. And many of us do not waver when faced with death -- I was scared as hell for about half an hour and then I didn't know if I should be or not - so I found out -- and heck -- all they were going to do was take out my larynx -- big deal. So I can't talk. naturally -- there are adaptive devices that keep QUALITY of life -- and I am also a doner and a no-coder -- I've read the stats. And I like adventurer -- and death can be one if you let it. In some ways, I look forward -- but I've seen so much, in so many ways, I wonder when and how -- but never why. And mostly briefly -- but have learned there are two ways to die: fast and slow. And fast and slow are relative -- I THINK it's the quality of your life that determines the difference between fast and slow.

Knowing you are terminal is hard enough, knowing that you have a point upon which to focus all that anger and rage only endangers the life of that fellow physician or doctor. People can have psychotic breaks when under too much stress -- and knowing you are terminal and knowing that a specific doctor 'killed' you -- can cause such a break.

Christ-- doctors have been shot and killed for preforming legal abortions -- and that life isn't even yours! -- And can you control the actions of you or your family? Did the doctor who mis-DX'd you 'Murder' your or 'Kill' you, or was it more like putting 2 1.2 cups of water in a recipe -- It might not be meat-loaf, but heck, it's more like meat-loaf soup. That's pretty good stuff, even if you wanted meat-loaf. We don't always get what we want. But there are people who feel the pea through several mattress. Do you have a right to kill the person who killed you? The State says they do, but you know they won't. Why not take it in your own hands, you are already dead. An Eye for an Eye -- The Torah and the Old Testament (or Covenant) both say it's OK. [Ex. 21:23, 24; Lev. 24:19, 20; Deut. 19:21]. If the State won't do it -- why don't you do it yourself -- God says it's OK THREE times, so it MUST be right, yes?

Please -- remember doctors are people, so are Physicians, we all make mistakes. Name a day you don't make one. Put you under pressure and will you make more or less? Do the same thing 30 times a day for a month, and then have a presentation the same symptoms, only the underlying cause is different -- will you make a mistake?

FIRST DO NO HARM. . . . Just because I'd want to know, doesn't mean I would want others to know -- And I've had plenty of times to tell on others and myself, and I will always tell on myself and never on others except to say 'the evidence for X can be sketchy at times' -- and keep the others 'clean'-- and if they are a 'problem' - there are channels -- there really are -- and a patient screaming law suit and a process server who's going to run up your insurance rates and take your house and part of your salary forever really makes that doctor do a better job -- you bet their attention will be 100% on their pt. and not on the law suit at all.

FIRST DO NO HARM -- why inflict more pain, more suffering, why spread it to the many others who are their friends -- and have them feel the same sorrow and anger that the pt. feels -- Let sleeping dogs Lie -- back channel the other physician -- or file with BMQA.

Give others the same rights and privileges you want for yourself, and remember, a doctor or Physician is no more a God than you are and is entitled to make a mistake -- there may be 'higher standards' -- And that CAT scan your doc ordered -- they didn't really need it -- an X-ray would have worked, and you got about 1000-10,000 times the radiation as a chest X-ray -- and it cost you (and me) a LOT of money -- but the patient who MIGHT sue you means you have to do it -- and a simple PA-LAT head X-ray would have given you a 95+% guess if you needed more information. So you get a greater chance of cancer in the future than you needed, because every doc has to be extra careful -- for probably
Pretty arrogant, Dr. T. You think you can really have the correct answer for another time and patient presentation. Clinical care is a series of single case on-off experiments. That a prior remedy failed means, you do not have to do it, and can move to another, making yourself look good, if it works.

Most medmal cases are weak, so say judges, juries and appellate courts, and at every stage of litigation. The expert witness has the litigation privilege that immunizes irresponsible declarations of superior knowledge. These irresponsible second guessers then get to boss the doctors of an entire state at the point of a gun of the government. These inexperienced academics get to impose their atavistic garbage science on far more experienced and intelligent clinicians.

This litigation privilege is to generate lawyer jobs. I do not differentiate between the evil that the defense bar does compared to the plaintiff bar. They work together to attack clinical care.

As a patient, I suggest that plaintiff experts and other arrogant second guessers get placed on a list. They get shunned by all service and product providers. If their boiler breaks in 0 degree weather, no heating technician may answer their call. If they enter a supermarket, security expels them without their groceries.
I disagree. I think that an oncologist isn't aware of what a primary physician may or may not have seen. I think that the oncologist should make a simple phone call to the primary physician and ask him if he noticed the lump on the xray from the year previous. Council him and find out what exactly happened and how me may of overlooked the spot. You never know if perhaps the doctor isn't as experienced in reading x rays.

My opinion is that you can't expose a fellow physician without talking with him first. He made the mistake and you should allow him to make ammends and confess his mistake. Perhaps you will realize that you are far more competent at reading x rays and that the family physician isn't. I just feel that there are a lot of slippery slope situations with black balling one another.

As a patient my main purpose is to get better and heal. I don't care what happened in the past, what mistakes may have been made. As long as I get better or the doctors do their best to help me. I just think it is a lot like a relationship. You can ask your partner how many people they have slept with but in the end it is useless information that you clasp on to when you are in desperate need of blaming someone for something. Trust your physician. Trust that they are genuine and earnestly seeking to make you as healthy as possible. And for hells sake, do your part!!! exercise, eat right, get your routine exams and vaccinations. If you have ever been told to do something by your Dr then ignore it... do you really care about your body?

Its funny that people all of the sudden take their health seriously only after they almost lose it. They don't care to listen until its too late and then you are too upset that you need to find someone to blame your problems on.

So in my longwinded rant, my final answer is this: do what you need to do to make me better. You may make mistakes and may miss subtle clues, but hindsight is always 20/20 and its easy to say you missed something once you know what to look for.
I see the doctors point. telling this woman delays and complicates her abilty to deal with her acceptance of impending death, not a small task. What then? There is also the need to effect the offending doctors practices and behavior so as not to negatively impact future patients.

That doctor should notify the first doctor immediately and let them know the consequences of their neglect and irresponsibility. But does it have the possibilty of effecting that doctor without the teeth that a malpractice suit would?. Hopefully there is some professional pride that would make him or her feel the need to repair their professional reputation by changing the way they do things. Repeated errors should be called out.
To answer your question , if death was imminent ( under six months) i wouldn't want to know.
If death was a couple of years a way , years involving surgeries ,chemo, financial duress, and discomfort I would definitely want to know so that I could pursue legal remedies if I so desired.
dijetlo has a write to a personal opinion but he/she has mistated the law.

There is no legal obligation to report a crime. There also is no legal obligation to help someone in peril.

Aiding and abetting requires consciously aiding in the commission of a crime, it does not apply here as an analogy.

I would want to know about the mistake simply because I would want to do something about it. I would confront that careless doctor and if I wasn't satisfied with their response I would take further action, either throught the licensing board or I would sue them to protect future patients and for the benefit of my family, who would lose a lot of really wonderful shared experiences and my grandchildren, who I wouldn't want to leave any earlier than I must.
Even dying folks are not yet dead and can participate as fully as possible morally and ethically in the lives and responsibilities they bear.

If I don't do my job well I don't get paid. If I was working for someone else I might lose my job. Doctors need to be held to similar high standards. Arrogance and c.y.a. are inappropriate and there are ways for doctors who make mistakes to make amends.

The irresponsibility of one doctor cost me a great deal. It marked my life and no matter how I have forgiven what happened, my body is scarred and was painful for years while it healed, I was unable to have children and my career track was derailed at the time. I spent a long time paying off medical debt that could have been avoided and was unable to afford things that I would have enjoyed. Even if I was going to die, since I know those are some of the consequences I would do my best to prevent those being someone elses consequences.
Darn I hate these tiny little comment boxes. That should have read "dijetlo has a right to..."
What about those left behind when this woman dies? An unnecessary death has consequences to others than just the patient. There may be children around and no provisions in place to care for the children. In a case like this, shouldn't the doctor be held responsible? The patient should be give the right to file a medical malpractice suit for the sake of her beneficiaries. So, yes, the patient should know.