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October 2005
Recommended Reading
Anne Ford
Fifty-four years ago, a young intern in Montefiore Hospital, New York
City, noticed that his patient, a teenage boy with kidney disease, had
severely scarred elbows. The boy explained that he often absentmindedly
leaned on the searing radiators in his family’s apartment because
he couldn’t feel their heat burning his skin. The resident physician
dismissed the intern’s suggestion that the boy might have Hansen’s
disease. Six months later, the patient began developing the facial deformities
associated with the disease, and a skin biopsy confirmed the diagnosis.
The amazed hospital staff started referring to not “Hansen’s
disease,” but “Hasson’s disease,” after the intern
who had made the correct diagnosis so many months earlier—Jack Hasson,
MD, retired associate professor of pathology, University of Connecticut
Health Center, Farmington.
Now, decades later, Dr. Hasson has written Why Even Good Doctors
Make Mistakes: An Anecdotal Introduction to Medicine.
Published in June, the book comprises dozens of anecdotes, each of which
describes a medical error or conundrum Dr. Hasson encountered during his
50-plus years practicing pathology. “Why should I bother at 75 years
of age to write a book like this?” Dr. Hasson told CAPTODAY. “It’s
a very simple answer. I want to see an end to this firestorm of medical
litigation that has paralyzed medical education. One of the basic misunderstandings
that is fueling medical litigation is an expectation by everyone concerned,
not only the public but doctors as well, that perfect practice is the
expected standard, and you simply can’t make mistakes. I want to
do what I can to banish that presumption.”
The pressure to be perfect, he adds, is in no one’s best interests—not
the doctors’ and not the public’s. Whereas hospitals once
routinely held “goof conferences” to review and learn from
staff errors, nowadays “the doctors, if they make a mistake, will
invariably conceal it,” Dr. Hasson says. “They don’t
want it discussed, because they’re afraid of it becoming discoverable
in court. We don’t have real peer-review conferences anymore. [And]
when you don’t review your mistakes, you make them over and over
again, and people are hurt.”
Dr. Hasson’s interest in this issue was sparked in the 1970s by
the birth of the medical litigation boom and the subsequent dramatic drop-off
in rates of autopsy. As he writes, “Requesting an autopsy [became]
a first step in self-incrimination.” After he retired in 2000, the
topic continued to preoccupy him. Decades earlier, he had completed a
book-length manuscript on the history and importance of autopsies, but
hadn’t been able to interest an agent. Now his own doctor—Michael
Grey, MD, MPH, professor of medicine and acting division chief of occupational/environmental
medicine at the University of Connecticut Health Center—suggested
that Dr. Hasson compile in book form the anecdotes he had shared with
medical students during his career. “I got a big bang out of remembering
all those cases,” Dr. Hasson says. “It brought back a lot
of memories.”
Because Dr. Hasson wanted laypeople as well as physicians to understand
what fuels medical litigation, he attempted to write the book in an informal,
accessible style—no easy task, as he discovered. “I’m
a doctor, and I’m as much a stuffed shirt as every other doctor
when it comes to writing,” he says. “It’s a handicap.
I needed a sounding board, and I preferred that it weren’t a doctor.”
He enlisted the help of his friend Razi Sharafieh (a video production
specialist with whom he had previously worked on an aborted project to
film autopsy dissection techniques). “I asked Razi if he would work
with me to make [the book] read like plain English. Let me tell you, I
could not have written that book without him,” he says, so much
so that he named Sharafieh his co-author. The book can be ordered through
iUniverse, a print-on-demand publishing house, by visiting www.iuniverse.com
or calling 800-288-4677.
One question Dr. Hasson has often found himself fielding since the book’s
publication: How on earth did he remember all the anecdotes’ details?
“I do have a terrific memory,” he says. But “you have
to understand that I’ve been telling these stories all my life.
I would use these experiences spontaneously to illustrate whatever I was
talking about to students. All my interesting, heartbreaking, exciting,
upsetting, wonderful cases, all of those had a diagnostic teaching point
to make. I’ve relived these experiences dozens of times.”
Dr. Hasson emphasizes throughout the book that while many medical mistakes
are preventable, some are simply not. One illustration of unavoidable
error took place during his tenure as attending pathologist at Montefiore
Hospital from 1966 to 1973. It was there that he encountered an 82-year-old
patient who had suffered a seemingly ordinary stroke. Rather than improving
gradually over two to three weeks as expected, the patient died during
the second week after developing pneumonia, which did not respond to antibiotics.
The autopsy revealed that the patient, having lost his cough reflex,
had aspirated saliva into his lower right lung. However, another, more
startling development was also brought to light: Despite suffering disorientation
and a paralyzed left arm and leg, the patient hadn’t had a stroke
at all. The lesion and edema in his brain were the result of a metastasized
lung cancer, which had gone undiscovered because it wasn’t visible
on X-rays. Without CAT scans—which would not become available for
about five years—there had been no way to discern the tumor. Meanwhile,
the autopsy revealed other metastases in the brain, lymph nodes, liver,
kidneys, and adrenal glands.
“This case illustrates how an unavoidable error may make no difference
in the outcome of a hopeless fatal disease,” Dr. Hasson writes.
Though the book is devoted to the topic of medical error, in its conclusion
Dr. Hasson briefly addresses other problems he feels must be solved if
the medical litigation crisis is to end. “All the money available
for any injury is only from the doctor’s liability insurance,”
he says. “One possibility is that some kind of accident compensation
insurance be available to patients. It could be done through a private
insurance company. The other possibility, of course, is that awful big
word: government. I didn’t want to get into that in this book because
it’s an extremely controversial subject.” He also proposes
that in cases of malpractice, a panel of physicians, lawyers, clergy,
and educated lay people be appointed in lieu of a jury: “Jurypeople
are laypeople, and they’re as much victims of the presumption of
medical infallibility as anybody else,” he says. “A good lawyer
can convince a lay jury of anything.”
Though Dr. Hasson is retired, the myth of medical infallibility and its
effects on medical education continue to disturb him. He did, after all,
experience it personally for many years. “After being visited by
professors of law from Harvard University in our hospital to lecture us
on medical litigation, what I wound up with was an impression that a lot
of doctors wound up with: ‘I’ve got to be perfect. If I’m
not perfect, I’m dead,’” he says. Meanwhile, “I
did make mistakes, and every time I did I went into an acute depression,
as all doctors do.” Not for another two decades did he realize that,
as he writes, “medical fallibility is unavoidable because the only
way to end it is to end medical practice.” Or, in more emphatic
terms: “It happens. You might as well learn from it.”
Anne Ford is a writer in Chicago. |
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