Finger Pointing, the Redux
Thank you to all of my followers who read and commented on my last post. I would like to expand a little bit on the subject of Duty. People have very different definitions of what their duty is in any given situation. In the case of the military, duty may be rigidly defined by hierarchy. In parenting, duty to your children is sort of a given part of procreation, but within parenting there are very different opinions about what that duty entails. Being “On Duty” may mean no more than being at work or “on the job”. Duty can also mean a tax or other monetary obligation.
In medicine the idea of duty has a significant meaning, both medically and legally. Most physicians understand that once they have accepted a patient it is their duty to care for that patient to the best of their ability, to take responsibility for what happens to the patient, or at the very least to provide them with access to other doctors who can care for them if the original physician cannot. Legally the determination of duty is an important one. Here is what one legal dictionary says about medical duty:
“…a more basic legal question involving medical care is the affirmative duty, if any, to provide medical treatment. The historical rule is that a physician has no duty to accept a patient, regardless of the severity of the illness. A physician’s relationship with a patient was understood to be a voluntary, contracted one. Once the relationship was established, the physician was under a legal obligation to provide medical treatment and was a fiduciary in this respect. (A fiduciary is a person with a duty to act primarily for the benefit of another.)”
This fiduciary bit is very important. In order to successfully prosecute a malpractice claim against someone the plaintiff must demonstrate the legal duty of the doctor to the plaintiff. No duty, no settlement. So even if a doctor never gets sued and has nothing but purely altruistic motives in all cases, the concept of duty is still relevant and an operating principle under which that doctor works. Why is this relevant to the issue I brought up in my last post, about physicians reporting other physicians? People who have been harmed and not informed talk about how their doctor didn’t talk to them, or they wouldn’t admit the error, or they failed to provide information, etc etc. It is absolutely true that the doctor, YOUR doctor, the one with fiduciary responsibility, must and should report/explain any errors or mistakes to the patient involved. No question. In a perfect world, everyone would always report the mistakes of everyone else without fear of retribution so we can all learn from the errors and improve our care and our systems. But doctors are human, and as such they have a very strong instinct for self-preservation, just like everyone else does.
If the patient upon whom the error occurred is not YOUR patient, ie. you have not entered into a legal contract with that patient to provide standard of care, it is very difficult to expect you to go out on a limb. Not only are you accusing a colleague of error, you are accusing him or her of failure in their legal duty to their patient. There are very few humans who would take kindly to that, in any field. Yes it would be great if all errors were reported, and yes the patient is the most important part of the equation, and yes in a perfect world doctors have nothing but all patients’ safety in mind at all times. Given that medical culture virtually guarantees that blowing the whistle on a colleague is likely to be more painful for the whistle-blower than for the colleague, reporting other doctor’s errors is very unlikely to occur. I’m not saying it’s right. I’m just saying it is.