The Whole Truth and Nothing But the Truth: Managing a Complication

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AUTHOR:
Neil Baum, MD
Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, LA

Author, Marketing Your Clinical Practice-Ethically, Effectively, and Economically, Jones Bartlett Publishers

It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5 mm by 10 mm, and it slipped from the forceps and was washed down the drain of the sink. I searched for the tiny sliver of tissue and even took the drain trap apart but could not locate it. I felt terrible and told the director of the pathology laboratory, who recommended that I call the urologic surgeon, Dr. Seybold, and report what had happened to the biopsy.

 
I called Dr. Seybold and he told me to meet him in the lobby of the hospital at 4 PM. I conjectured all morning and afternoon at what was going to happen at that meeting. I even imagined that I would be reported to the program chairman and might be fired and asked to leave the program.
 
Dr. Seybold was in the lobby at exactly 4 PM and we walked to the business office. Dr. Seybold asked for the head of the department and told them what had happened. He wanted to repeat the procedure the following day and asked if the patient would not be charged for the extra day in the hospital or for the second because the problem was created by the hospital and was not the patient’s fault.
 
We then went to the operating room and met with the head of anesthesiology and asked if they would not bill the patient for the anesthesia for the second procedure. The anesthesiologist was very understanding and they agreed to waive the additional fee.
 
Then we went to the patient’s bedside to inform the patient of the event. Dr. Seybold sat down beside the patient and explained that the specimen was lost. He did not blame me but did state that the specimen was lost in the pathology laboratory. He told the patient that we could do the procedure as the first case the next day and that he would ask the laboratory for an expedited reading of the slide and that he would likely be discharged with the diagnosis 2 days later. The patient was clearly disappointed but agreed to the plan of action as laid out by Dr. Seybold.
 
Dr. Seybold then took me to one of the private conference rooms and told me that what I had just witnessed was the proper way to handle a complication. He told me that all doctors can expect to have complications and mistakes will happen. He said the best way to manage these issues is to be forthright, honest, tell the patients the truth, and accept full responsibility. Patients will understand an honest mistake if the doctor tells the truth. It is when doctors make excuses or falsify the facts that patients become angry, hostile, and litigious. It is this invaluable lesson that I learned as a young resident that I have passed on to medical students and residents that I have mentored. This advice worked well many years ago and it is still good advice today. I believe Dr. Seybold’s message will be helpful to every doctor who is confronted with a problem or a complication.
 
By the way, I accompanied Dr. Seybold to the operating room and hand-carried the tissue to the laboratory, where I carefully placed it into the appropriate cassette and took it to the technician to prepare the slides. The final pathology report was benign, and both Dr. Seybold and I gave a sigh of relief.