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PRACTICE TIPS & TRICKS Lessons Learned the Hard Way

By: Neil H. Baum, MD, Tulane University School of Medicine, New Orleans, Louisiana | Posted on: 17 Jul 2024

The practice of medicine is a great teacher. I admit I have made mistakes; however, I have tried to learn from my errors. In this article, I will share two stories of personal blunders and the lessons learned from these errors.

One of my best learning experiences occurred in 1976 when I was a junior resident in urology at Baylor College of Medicine in Houston. I was assigned to a 3-month pathology rotation, where my job was to process specimens taken at surgery, dictate a gross description of each specimen, and then place them into the cassettes used to make the permanent sections.

While I was transferring a prostate biopsy, it slipped from the forceps and was washed down the drain of the sink. I took the drain trap apart and searched for the 0.5 mm × 10 mm (1/6 in × 1/2 in) sliver of tissue, but I could not locate it. I felt terrible and shared the news with the director of the pathology lab, who recommended that I report what had happened with the biopsy to the urologic surgeon, Dr Herbert Seybold.

I called Dr Seybold, and he told me to meet him. I worried about what would transpire at that meeting. I even imagined that I would be reported to the program chairman and might be asked to leave the program.

Dr Seybold and I walked to the business office. He asked for the head of the department and explained that he wanted to repeat the procedure. He asked not to charge the patient for the extra day in the hospital or the second operating room procedure. Next, he asked the anesthesiology department not to bill the patient for the second procedure.

We went to the patient’s bedside to inform the patient of the event. Dr Seybold sat beside the patient and explained that the specimen was lost and that we would need to do another biopsy. He did not blame me but stated that the specimen was lost in the pathology lab. The patient was disappointed but agreed to the plan of action.

Together, we went to private conference rooms, and he told me that was the proper way to handle a complication or mistake. He told me that all physicians can expect complications and that mistakes will be made. He said the best way to manage these issues is to be forthright and honest—tell the patients the truth and accept full responsibility. Rarely will a patient become a problem if the doctor tells the truth.

This advice worked well years ago and is still applicable today. I believe Dr Seybold’s message will be helpful to every urologist who is confronted with a problem or a complication.

The rest of the story: What happened to the patient? I accompanied Dr Seybold to the operating room for the second procedure, hand-carried the tissue sample to the lab, and oh-so-carefully placed it into the appropriate cassette. The final path report was benign, and all three of us—Dr Seybold, the patient, and I—breathed a sigh of relief.

So, the take-home message of this story is to always tell the truth. There may be consequences for telling the truth, but they will be less than if you withheld the truth and got caught in a lie. People will respect you for the truth, and seldom will you burn a bridge for your honesty.

The second story involves a relationship with a pharmaceutical company. I had several conversations with the marketing director, and he was to contact me regarding a project. I didn’t hear from the director after sending him multiple letters and emails, including a FedEx letter.

Feeling frustrated by the lack of response, I wrote him a letter stating that if I didn’t receive any follow-up, I would contact the company president and relate my experience and the marketing director’s lack of follow-up.

Shortly after that, I received a call from the director’s secretary stating that his wife had terminal breast cancer and that he had taken a leave of absence to care for his wife.

I overreacted as I did not know all the information about his wife’s dire situation. The lesson I learned is to get all the information before concluding or before acting. Had the secretary contacted me and told me that the director had taken a leave of absence due to personal circumstances, I would have understood and dropped my request for follow-up. Since that didn’t happen, it taught me to obtain the necessary information and act. I should never act without obtaining the reason behind the situation.

Well, I hope these stories provide some examples of managing a mistake or error and when more information is necessary before speaking or writing. If you have any stories that you would like to share about lessons learned from your patients and your practice, please let me hear from you at doctorwhiz@gmail.com.

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