Cape Town - A family member of mine took her baby girl to the doctor with a weeping birthmark.
The treatment given made the birthmark a lot worse, and they went back to seek advice. The doctor became defensive, insisting that the correct treatment had been given.
There was an attempt to shift the blame to the parents. They were troubled by the way they were treated and felt the doctor did not care. This episode made them cynical towards health-care professionals in general.
This story caused me to reflect on the difficult conversations doctors regularly face and how to handle situations where treatment did not go to plan.
Together with professors Mathys Labuschagne and Gina Joubert, I asked whether medical students were adequately prepared for the daunting task of disclosing medical errors.
There is a myth that doctors should be perfect and that a good doctor should never make any mistakes. However, medical mistakes remain common despite increasing patient safety measures worldwide.
These mistakes can have severe consequences for the patient. They can also have profound effects of guilt and self-doubt on the doctor, as well as litigation.
According to a study at the University of the Witwatersrand (UWS) in 2017, the main barriers to error disclosure in South Africa are fear of victimisation by colleagues and fear of litigation.
None of us like making mistakes and it can be tempting to try to hide mistakes rather than admitting to them. However, doctors are expected to be honest and open even when treatment did not go to plan. Researchers found that patients were less likely to pursue legal action when they received a clear explanation from the doctor following a medical error.
When researchers asked doctors whether error disclosure was the right thing to do, more than 70% of them said yes.
However, when asked whether they had disclosed their last error, only 16% replied in the affirmative. There was an apt description of this contrast between beliefs and behaviour in 2013: “Ethics says yes, but instinct says no” (Detsky, 2013).
Admitting errors is difficult and will not come naturally. Medical students must be intentionally taught how to face these difficult situations, but are they?
Error disclosure has been included in the UK medical communication skills curriculum for some time.
However, in the South African setting, researchers found that specialists and postgraduate trainees reported little training in this complex communication skill (Moodley et al, 2021).
In terms of undergraduate students, there was hardly any information regarding training in error disclosure.
Students at the UFS Medical School were asked to review training they had received in the disclosure of medical errors.
These findings were interpreted in the light of available literature. This formed part of a wider study in which medical students reviewed the communication skills training they had received as undergraduates.
The study had a cross-sectional, descriptive and quantitative design. Fourth- and fifth-year medical students at UFS completed anonymous questionnaires to review the doctor-patient communication skills training.
The findings showed that almost three-quarters of fourth-year students (73.9%) and considerably more than half of fifth-year students (61.1%) reported that training in error disclosure was infrequent.
Almost half of the fourth-year students (49.2%) rated themselves as novices in this skill, while a little over half of fifth-year students (53.3%) rated themselves as average in this skill.
This is an area where there is a huge need and an opportunity for professional growth through learning and teaching.
Role modelling of the right behaviour is essential. Medical educators should nurture honesty and humility in medical trainees so that patients can trust medical graduates.
Dr Swinfen is a lecturer and medical officer in the School of Biomedical Sciences, University of the Free State . Her research on which this article is based recently won the first prize in the Best Educational Paper in the Junior category at this year’s Faculty of Health Sciences Research Forum.
** The views expressed do not necessarily reflect the views of Independent Media or IOL.