After a medical error, doctors need a just culture, not blame

In 2005, as a fellow, general surgeon Scott Ellner had his first sentinel event, a clamp left in a patient's abdomen. Afterward came shame, blame, and guilt instead of a just culture. He explains second victim syndrome, what an apology can do after a medical error, why he says to check with legal counsel first, and why a just culture starts with the board. ⏱️ Chapters: 0:00 Introduction 0:39 A clamp left in a patient's abdomen 1:53 Shame, blame, and guilt instead of a just culture 2:55 What goes through a doctor's mind after a mistake 3:59 Feeling alone with no support 4:57 What second victim syndrome is 6:23 What just culture in health care means 7:21 A surgeon shares what happened with a patient's husband 9:06 Why an apology matters after a medical error 10:26 Check with legal counsel before you apologize 11:46 Why just culture starts with the board 15:42 Training leaders in high reliability and just culture 16:14 Psychological safety and the courage to speak up 17:04 Take home messages About this episode: Scott Ellner is a general surgeon and a physician executive at Peak Health Technologies. In his KevinMD article, "Humanism in health care: how to address patient harm," he describes a 2005 operation during his fellowship in which a Kocher clamp was miscounted and left in the patient's abdomen, after which attorneys told the team not to say anything or disclose anything. Aside from his family, he says, he felt alone. Second victim syndrome, a term coined by Albert Wu, describes the health care professional involved in unintentionally causing harm, who can become despondent, turn to substance abuse, or consider leaving the profession, and he notes that 70,000 physicians left the workforce between 2021 and 2022. In a just culture, he says, people feel they can speak up, and everyone takes accountability instead of blaming or pointing fingers. He tells of a colleague who was told by legal counsel that it was OK to show sympathy and who shared what happened with a patient's husband, and he cites attorney Richard Boothman's finding that malpractice claims are reduced when clinicians apologize in the right context. He is careful not to give legal advice and suggests checking with legal counsel first. A just culture starts with the board, which should hold the CEO accountable, and he points clinicians to the American Medical Association helpline and the Dr. Lorna Breen Act, passed in 2022. 🤝 Partner with me on the KevinMD platform: With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Let's work together to tell your story. ➡️ PARTNER WITH KEVINMD: https://kevinmd.com/influencer ➡️ SUBSCRIBE TO THE PODCAST: https://www.kevinmd.com/podcast ➡️ RECOMMENDED BY KEVINMD: https://www.kevinmd.com/recommended #JustCulture #PatientSafety #MedicalErrors