Godofredo U. Stuart Jr., MD
This is a response to a commentary that appeared in the Philippine Inquirer editorial page, written by Thaddeus C. Hinunangan, a resident pathologist at the Philippine General Hospital: Are Doctors Allowed to Make Mistakes?
No, doctors are not allowed to make mistakes. Not in the noble intentions of medicine, framed in that motto phrased centuries ago by Ambroise Paré: Guérir quelquefois, soulager souvent, consoler toujours—To cure occasionally, relieve often, console always.
But in the practice of medicine, human error is inevitable. We assuage ourselves with half a proverb: To err is human. But because of medical errors, patients die.
Are doctors allowed to make mistakes?
By: Thaddeus C. Hinunangan
(05:02 AM October 22, 2017)
The crowd had left, and I was picking up the projector and the rest of my stuff in the conference room. To say that I had messed up was to make an understatement. A last-minute biopsy slide, which turned out to be that of a different organ, was probably the worst that could happen to a pathologist in training. Oh, my God, I thought, there is no recovering from this one. I had failed to adequately establish the cause of the patient’s death.
Many people view doctors as infallible. That was my perception, too — until I began the journey of becoming a doctor myself. It’s more of a burden for pathologists because clinicians depend on us for diagnosing malignancies, classifying or staging tumors, or confirming infections that would have serious implications on the treatment approach. Meaning: A misdiagnosis might result in the surgeon removing a benign breast or kidney, or the oncologist administering the wrong chemotherapy protocol, or clinicians undergoing the nightmare of over- or undertreating their patients.
I have tremendous respect for my fellow residents and consultants. More often than not, after a less than desirable score on the monthly exam where we are ranked, or missed lesions on microscopy, I doubt whether I should continue. Being in this specialty requires one to be objective, methodical and precise — three adjectives seldom used to describe me. While my colleagues were completing secondary education in science high schools, I was a college student during the day and a call center agent at night. Almost every move on their part was geared toward the goal of becoming the specialist they intended to be. In my case, I started late in medical school in the province, with the intention of becoming a general practitioner.
Almost a year into training, I am still adjusting in a major way. Distinguishing benign lymphocytic proliferation from lymphoma and further subclassifying require years of study, and up to now, doling out a diagnosis of cancer makes my heart beat faster. Of course, the fact that I’m alone in this journey — my brothers, my only family left, live abroad — does little to help. Homesickness presents a constant struggle, but I have been in frequent touch with pathologists in my native Leyte for encouragement and direction. Training in Manila comes at a high price, and I hope that when I go home to practice in the province one day, it would all be worth it.
I had felt this overwhelming longing to be with family and something familiar and comforting, but I needed to again head to the morgue to get additional tissue sections, to correct my mistakes in the diagnosis. I needed to prove in this case that mucosal and submucosal erosions and profuse bleeding from enteropathy had killed the patient.
I laid out the organs on the steel table, and began unraveling the colon. An image flashed in my mind: the patient’s face, not when his body was undergoing my autopsy, but the way he looked in his ID card as a fresh graduate. He was young, and his siblings were at a loss as to what had really happened to their brother.
I thought I owed it to the patient to find the truth about his demise.
For a moment, I forgot about my own problems and focused on the task. But there was a lump in my throat and tears began to blur my eyes. Maybe it was the formalin, or maybe it was just me.
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Thaddeus C. Hinunangan is a resident pathologist at the Philippine General Hospital.
http://opinion.inquirer.net/108076/doctors-allowed-make-mistakes