a dangerous apology

television can teach you some pretty cool stuff. for example, i remember watching the pilot episode of “house” and being thoroughly fascinated with the notion that a tapeworm can find its way into a person’s brain and wreak havoc there. later, i learnt about opportunistic infections and the funky assortment of organisms that can infect the brain and even show up on imaging studies like a scene out of a horror flick. but nothing compares to the initial intrigue i felt when house had his lightbulb moment and identified the parasite, right at the debut of his show.

likewise, i got a glimpse of how screwed up the law can be a couple a weeks ago, during an episode of “the good wife”. a high school football player died of an overdose of prescription drugs and the attorneys at stern, lockhart and (sigh) gardner were called in to defend the doctor whose name was on the bottles of drugs found in the athlete’s bag. the first thing alicia florrick did was call the doctor aside and tell him not to comfort the family members because any sympathy or an apology can be interpreted as an admission of guilt.

that puzzled me. we are taught day in day out that it’s important for us to be humble, to admit mistakes. not to the extent of degrading the profession, of course, but doesn’t it make sense to say “i’m sorry” when you’re wrong? isn’t it human to express guilt or remorse?

this morning, an article from medscape (“when saying ‘i’m sorry’ is the worst thing you can do“, registration required) brought the matter to my attention once more. it outlined the repercussions a physician can face just by saying he or she is sorry. the hospital may distance itself from the doctor, the insurance premiums may increase, and the admission of guilt may be brought against the doctor in court via testimonies from anyone who was within earshot (apparently hearsay doesn’t apply in these cases). prosecutors are also more willing to prosecute because really, with that admission, the case is in the bag.

worst of all, professional bodies are pressured to punish physicians who get embroiled in these cases and a doctor isn’t a doctor when his or her license has been revoked.

the article even has a confusing “guide” on what to do if you, a doctor, realise you’ve made a medical error. it involves malpractice insurance carriers, personal healthcare attorneys, and getting a recording of the actual post-incident talk with patients and/or family members…just to make sure you say sorry the right way. the non-incriminating way.

it concludes with “although an apology may help you purge your guilt, it could harm your career and be financially ruinous. thus, be careful about what you say and how you say it. don’t rush to alleviate your guilt at risk of losing your career.” it sounds so self-serving, like there’s no humanity left in the management of a patient’s grief. and yet, it is a necessity.

the things we learn from television.

i no longer have delusions about medicine being an altruistic discipline. after all, 80% of my desire to see my patients get better involve self-glorifying motives. only 20% comes the satisfaction of sending a person home less ill than he was when he first came in. when it comes to dealing with the messed up system the law has become these days, i guess it shouldn’t surprise me that the same selfish notions come into play as well.

“the good wife” is an excellent show, by the way. the writing is amazing, the acting is impeccable. i officially have a crush on will gardner, and juliana margulies fully deserves her golden globe and screen actors guild awards. i’m also falling in love with a courtroom drama again, long after “the practice” died its painful death. definitely the best new show of 2009.

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