Dr. Danielle Ofri’s Grand Rounds: Medical Error in Modern Medicine

It is human to err. This saying is commonplace, echoed in education and work, in our many interactions. The human experience is defined by error, yet we as humans continue to alienate ourselves from it. Unfortunately, our tendency to deny our misdoing is just as innate as our capacity to make mistakes. For Dr. Danielle Ofri, a renowned author and practicing physician at Bellevue Hospital, nowhere does this truth more strongly resonate than in modern medicine. Technology, expertise, and specialization is dominating our understanding of mortality and suffering, while complicating the doctor-patient connection.

As patients cross the threshold into the hospital, state-of-the-art and personalized care is expected. Doctors have the difficult task of simultaneously maximizing efficiency and attuning to the individualities of patients. As a result, physicians often develop shortcuts – mental heuristics – to arrive at near-immediate diagnoses. This is deeply problematic, considering there is simply no room in the veins of the medical system for the fallacy at the heart of our humanity. In her insightful talk at Bondurant Hall, Dr. Ofri delved into these issues of patient safety and medical error at the frontlines of our national medical conversation.

Dr. Ofri began her presentation with a thought-provoking anecdote illustrating her experience with error as a medical student. She had requested brain scans on a patient and received them from radiology, yet overlooked them. The scans contained evidence of a critical anomaly in the neural tissue. While the error was ultimately detected by the attending physicians supervising her, the ordeal was seared into her memory. She described how she questioned her merit as a physician, and was subdued into silence for nearly twenty years after the incident for fear of the humiliating consequences. It is this culture of perfectionism in medicine that Dr. Ofri repeatedly called to criticize and dismantle. By refusing to voice her misstep, Dr. Ofri admitted that she delayed an important moment of self-reflection that all physicians must undergo upon erring. It is only after examining the origins and impacts of their errors that physicians can enrich medical practice.

After identifying these personal connections with medical error, Dr. Ofri expanded her discussion of the medical error crisis to depict its inner workings. She disclosed that the very definition of error is blurred, particularly in the web of complex health and disease coupled with individual patient profiles. It is, however, valuable to recognize how patient satisfaction and recovery outcomes are jeopardized in the context of physicians’ mental shortcuts and biases. Dr. Ofri further explored the diagnostic, educational, and cognitive causes of medical lapses. These variables all greatly complicate medical decision-making, which is already an involved process socio-culturally and morally. The thousands of decisions doctors make each day, Dr. Ofri emphasized, are not only intellectually filtered, but also emotionally connotated. Removing one’s colored perceptions to conduct an impartial diagnosis is a challenging, if not impossible feat.

Whether a minor misstep or a momentous blunder, lapses in medicine are often inevitable. Physicians cannot surgically remove their humanity from a practice grounded in understanding the human condition. How, Dr. Ofri then questioned, can we begin to both illuminate and embrace error in the unforgiving field of medicine, while de-stigmatizing physicians’ admissions of wrongdoing?

The answer lies in fostering a culture not of error removal, but one of error mitigation.  The medical system must dismantle the reigning standard of perfection, which excludes the opportunity for improvement that error offers. Dr. Ofri encouraged physicians to consider the emotions of empathy, guilt, and shame underpinning the occurrence and aftermath of error. Instead of making them the cracks and splinters of medical practice, healthcare providers must mobilize on them as bridge points between doctor and patient. By citing several stories of errors that demoralized doctors, Dr. Ofri underscores that while physicians make the error, they cannot consider themselves the error. Alongside concrete interventions such as checklists, medical education and training must restore in physicians the emotional courage to accept vulnerability. Only then will the medical system begin unveiling the toxic perfectionism and denial that buries error at its core.

 


Mili is a student with an interdisciplinary love for the hard sciences and humanities. She is particularly interested in pursuing trauma and critical care, and wants to deepen her understanding of individual patient experiences in the field of medicine.

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