Since my post yesterday about the article in the Chicago Tribune about doctors apologizing, a handful of readers have sent me an email asking whether the doctors involved in my misdiagnosis debacle ever apologized to me.
Good question! and the answer is yes… and no…. Truth is, I didn’t give them much choice.
There were three doctors I held accountable for my misdiagnosis and resulting almost-treatment fiasco. At the end of my odyssey, I wrote a long memo to all the doctors involved in the process — the good guys and the bad guys. It was addressed to the mistaken ones, and copied to the others.
The three I was most upset with were the two pathologists and one oncologist. If you’ve read my story, you know I was told that that two different labs had confirmed my diagnosis of a rare, aggressive lymphoma — as I understood it — one lab reviewed the biopsy, then forwarded it to another lab for a second opinion. From there, the information was forwarded to the oncologists.
So here’s how each responded:
Pathologist #1 is Doctor E. She heads up the first lab that looked at my biopsy and when I followed up my memo by phone about 10 days later, I did have a good discussion with her. She did apologize for the mistake. She also told me about the protocol used to transfer a case from one lab to another, because I couldn’t understand how two labs could get it wrong. It turns out that “transfer protocol” calls for lab #1 to tell lab #2 what their conclusion is, i.e. “Here’s a speciman. We think it’s X. What do you think?”
OK — how many of you took basic science in 6th grade? Do you remember learning about blind studies? I almost fell down when Dr. E told me what the protocol was. Clearly, there is NO request for an objective second opinion! All the second lab is being asked is whether they can confirm the diagnosis — they are not being asked for a second opinion. And the mere suggestion of a certain diagnosis then influences the confirmation. There is nothing objective about it at all.
Pathologist #2 is Doctor R. He heads up the second lab that took a look at my biopsy and confirmed the same as lab #1. He was actually quite open about how the mistake had been made and I learned two things from him.
First, he blamed the fact that because my biopsy had arrived at the lab on July 1, a weekend and the start of the July 4th holiday, they had nobody in the lab with enough experience to review such an unusual biopsy. (Take note — no matter how much the health literature written by doctors will tell you this isn’t true — when it comes to any kind of elective healthcare, always avoid summer holidays and end-of-the year holidays if you can!)
Second, he told me that in med school, he was taught that no doctor is perfect; to expect to make mistakes. But if a mistake had to be made, always err on the side of making sure someone WILL be treated rather than erring on the side of not treating a patient who needs it. OK. As much as they ended up being a nightmare for me, I can buy that.
The oncologist – Dr. H — was another story. In the memo I sent to all the doctors, I most chastised him, and suggested — no, accused — him of insisting I begin chemo because it was the only way he could make money off me. Surprisingly, he never even replied to that accusation (and it still stands, as far as I’m concerned.) However, what he did do was send me a three page letter, coming down on ME for “unfairly impugning my professional reputation.” He went on to explain why he had been RIGHT to insist I begin chemo (when there was plenty of evidence pointing to a possible misdiagnosis.)
I sent a reply to Dr. H, pointing out that, in fact, he had been the one to err, not me, and if anyone was impugning anything, it was him. I also stated that I was only looking for apologies, and for a zero balance on my account (why should I pay for their mistakes?) and was not intending to file any official complaints or lawsuits.
A few weeks later, I received a follow up letter from Dr. H., with a kinda-sorta apology, phrased like this, “I’m sorry if you were unhappy with your experience with me.”
So that’s the story. For those of you who read this blog regularly, or read my columns or listen to my radio show, you know I don’t dwell on any of it. I use my misdiagnosis as the springboard for my work — but dwelling on the details isn’t something that moves anyone forward except as the details present good examples for the points I try to make for sharp patienting.
And perhaps that’s the whole point about extracting an apology from a healthcare provider who has wronged us. When we know that someone else has recognized a mistake, and truly feels bad that it has happened, then we ourselves can begin to move on. It’s a form of closure. It allows us to begin putting the situation behind us to deal with whatever our new reality is.
My advice to patients about doctor apologies is this: if you know you’ve been the victim of any form of medical error, and you don’t see those providers involved stepping up to the plate — then ask them to! If it makes the squirm? Well — that’s THEIR problem, not yours.
Insist they own up to their mistakes. If that involves an apology, so be it. And if you have to be tough, even bitchy — then go for it. Because at the end of the day, YOU are the one who must move on. And insisting someone else take responsibilty for the actions that YOU must pay for can be very empowering.
P.S. to the Joint Commission: there was nothing “unanticipated” about the outcome of the mistakes made by these doctors. Nothing at all. The only thing unanticipated was how I would react by being misdiagnosed. I dare say none of the doctors involved ever thought I would change careers to help right the ship of our failed American healthcare system, now did they?