Errors, Guilt and Shame in Medicine - Dealing with Enchantment and Fright
Kurt Schmidt, Doctor of Theology / University Degree, Director, Center for Medical Ethics
In its 2000 report "To err is human", which attracted attention worldwide, the Institute of Medicine calculated that every year somewhere between 48,000 and 96,000 patients in the USA probably die as the result of a medical error. And if there are no structures in place within the team or hospital to help and support the colleague concerned, then he or she is in danger of becoming the ‘second victim’. The maelstrom which the individual can become caught up in is unfathomable. The relationship of trust between patient and/or next of kin and physician suffers. Dealing with medical errors means not only dealing with medical, ethical and legal issues, but also dealing with deeply existential emotions (shame) and religious or spiritual needs (assumption of guilt, forgiveness). Tragically, these emotions and needs are often inadequately taken into account, sometimes not even addressed at all.
With regard to erroneous behavior it is, however, important to differentiate. An error could be a minor error, a near error which could be avoided at the last moment, a visible error which accompanies human beings for the rest of their lives, or a severe error leading to death. In the last case the perpetrator cannot apologize to the victim, and the dead victim cannot forgive the perpetrator. Can parents who have lost their child because of a medical error committed by an emergency physician forgive that physician in lieu of their dead child? And how can individuals continue to live with their feelings of guilt?
The "enchantment" inspired by the healing powers of medicine can turn to fright. Key aspects of medicine, such as hope, trust, truthfulness or the assumption of responsibility, enter a crisis. As a further training measure, "medical errors" is not a pleasant topic, and direct confrontation with personal errors is difficult. It is therefore crucial that a sensitive approach is adopted in order to create a willingness to tackle this area of conflict, incorporating technical viability and spiritual needs. The concept of our model is to use tales and stories to create the necessary distance. From Ancient tales and Bible stories, via the performing arts and theater, up to present-day movies and TV shows, stories of human error and its consequences, followed by the search for forgiveness, have been told and retold time and again. The world changes for all those involved after such an event. The question poses itself: how can life go on under the shadow cast by errors and guilt?
As impulses in seminars, cinematic examples are capable of playing through possible incidents in the sense of preventive ethics, inviting employees to develop helpful structures which will help to provide a constructive landscape of support options for superiors, colleagues and the entire organization in the aftermath of a critical incident. Only then will the employee concerned not become the ‘second victim’, and only then will enchantment with medicine not turn to lifelong fright.
In its 2000 report "To err is human", which attracted attention worldwide, the Institute of Medicine calculated that every year somewhere between 48,000 and 96,000 patients in the USA probably die as the result of a medical error. And if there are no structures in place within the team or hospital to help and support the colleague concerned, then he or she is in danger of becoming the ‘second victim’. The maelstrom which the individual can become caught up in is unfathomable. The relationship of trust between patient and/or next of kin and physician suffers. Dealing with medical errors means not only dealing with medical, ethical and legal issues, but also dealing with deeply existential emotions (shame) and religious or spiritual needs (assumption of guilt, forgiveness). Tragically, these emotions and needs are often inadequately taken into account, sometimes not even addressed at all.
With regard to erroneous behavior it is, however, important to differentiate. An error could be a minor error, a near error which could be avoided at the last moment, a visible error which accompanies human beings for the rest of their lives, or a severe error leading to death. In the last case the perpetrator cannot apologize to the victim, and the dead victim cannot forgive the perpetrator. Can parents who have lost their child because of a medical error committed by an emergency physician forgive that physician in lieu of their dead child? And how can individuals continue to live with their feelings of guilt?
The "enchantment" inspired by the healing powers of medicine can turn to fright. Key aspects of medicine, such as hope, trust, truthfulness or the assumption of responsibility, enter a crisis. As a further training measure, "medical errors" is not a pleasant topic, and direct confrontation with personal errors is difficult. It is therefore crucial that a sensitive approach is adopted in order to create a willingness to tackle this area of conflict, incorporating technical viability and spiritual needs. The concept of our model is to use tales and stories to create the necessary distance. From Ancient tales and Bible stories, via the performing arts and theater, up to present-day movies and TV shows, stories of human error and its consequences, followed by the search for forgiveness, have been told and retold time and again. The world changes for all those involved after such an event. The question poses itself: how can life go on under the shadow cast by errors and guilt?
As impulses in seminars, cinematic examples are capable of playing through possible incidents in the sense of preventive ethics, inviting employees to develop helpful structures which will help to provide a constructive landscape of support options for superiors, colleagues and the entire organization in the aftermath of a critical incident. Only then will the employee concerned not become the ‘second victim’, and only then will enchantment with medicine not turn to lifelong fright.