Why can't our doctors say sorry?

General News - Thursday December 20, 2007

COMMENTARY

Why can't our doctors say sorry?

SANITSUDA EKACHAI

The medical profession was hit by a bombshell early this month, when a doctor was sentenced to a three-year jail term for a medical error which killed her patient.

Shock and fury reigned in medical circles when Dr Suthiporn Kraimark, a physician at Ron Phibun Hospital in Nakhon Si Thammarat, received an unprecedented jail sentence for administering the wrong dosage of anaesthetic to Somkuan Kaewkongchan during an appendicitis operation, which caused Somkuan's death.

Since occasional mistakes in medical diagnosis and treatment are unavoidable, many doctors have threatened not to perform any operations or refuse to treat risky medical cases for fear of lawsuits and jail sentences.

The doctors in rural state hospitals are particularly upset. They say in unison that it is unfair to punish them when they are actually sacrificing themselves to work in a very punishing environment with an overwhelming workload and little infrastructural support to give high-quality services, not to mention relatively little income.

Is this what they get for their sacrifice, they ask angrily.

Instead of trying to calm the physicians' anger and improve patient-doctor relations, the Medical Council has vowed to protect its members from criminal lawsuits, despite the dramatic rise in the number of fatal medical errors nationwide.

Apart from setting up a strong legal team to fight malpractice lawsuits, it has drafted medical guidelines to justify physicians' refusal to treat patients by citing non life-threatening symptoms or lack of equipment and specialisation. It is also drafting a law to excuse physicians from criminal liability.

These self-protective moves reflect total heartlessness towards patients. And this is where the crux of the problem lies.

Much has been said of the need to improve the medical infrastructure at state hospitals to reduce the workload so the physicians have time to talk to patients for more accurate diagnoses, as well as to provide them with better health services.

On the patients' side, they also need to do more about self-care so they don't overload the hospitals with minor illnesses that can be prevented by regular exercise or healed by simple herbs.

But even when these two requirements become a reality, medical mistakes are still unavoidable.

And the lawsuit problem won't go away if the doctors cannot accept their mistakes.

More often than not, all the patients and their relatives want is an honest explanation of what happened, and a sincere apology for what went wrong.

Instead, what they get is indifference. And when they persist, they are challenged to go to court, with the physicians' full confidence that their difficult medical jargon will win the court's ear and reduce the patients' complaints to mere emotional, ignorant appeals.

The question is: why do doctors feel it would be stooping too low to say sorry, to express sympathy to the patient's grief-stricken relatives and take steps to make amends?

In court, they are strongly backed up by the Medical Council to fight to the end. It is not only out of fear of setting legal precedents which possibly could encourage more lawsuits, but also the inability to accept mistakes.

This boils down to saving face, arrogance and ego.

Interestingly, not all medical errors end in court. There is a strong indication that when the doctors sincerely expressed their regrets and made efforts to ease the patients' and their families' grief, the painful incidents ended in mutual understanding.

Can other physicians learn from this?

"Saying you're sorry might make you feel like losing face. But in fact, what you lose when you ask for forgiveness is your own ego, your own arrogance," advises Buddhist monk Phra Paisan Visalo, on how to mend hurtful relationships."It's not difficult to ask for forgiveness. Just open your heart to others' suffering. Saying you're sorry won't only ease the other party's pain, it will free you from the cycle of hostility and conflict. It's also an invaluable chance to renew your humanity."

Sanitsuda Ekachai is Assistant Editor (Outlook), Bangkok Post.

Email: sanitsudae@bangkokpost.co.th

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