2024-01-07 11:23:09
In 1983, Neil McIntyre, a professor of medicine, and Karl Popper, a philosopher, wrote an article entitled, The Critical Attitude in Medicine: The Need for a New Ethics. I translate the opening sentences: “In medicine, like in other professions, errors happen. Sometimes the consequences are trivial, but often they are serious, and other times they can be catastrophic. A way must be found to correct the errors; Unfortunately, in many cases the damage is irreversible. The only benefit that can be derived from a mistake is to avoid it in the future.”
The topic “erring in medicine” is fascinating. It is, because it is always necessary to go to the doctor. Even mothers who give birth to babies with the help of midwives, due to poverty, principles or distrust in doctors, sooner or later require the assistance of a pediatrician for their sons/daughters. For convenience I list some reflections:
1. Errare humanum est is a great old idea. Everyone knows: To err is human. Learning from mistakes is essential.
2. In Latin, the original expression says, Errare humanum est, sed perseverare diabolicum, an adequate and intelligent concept: “To err is human, but to persevere in error is diabolical.” That idea should be medical school.
3. Not being contumacious, ie, “remaining firm in your behavior, attitude, ideas or intentions despite punishments, warnings or advice”, in medicine (and in life) is essential.
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4. There are three sources through which one learns and grows in medicine: from books, from patients, from experience. Young doctors drink from all of them: from books and magazines, the theory; of patients thanks to the clinic, whose etymological origin comes from the Greek, “care for patients in bed”, and from experience, thanks to the teachings of the teachers. Whoever sticks to that triad makes fewer mistakes.
5. Criticism is a beautiful word. From the Greek krinen, it means “able to discern,” as well as “separate, decide, judge.” Whoever submits to criticism grows. You improve from your successes and you progress when you reflect on your mistakes. In medicine, criticism is essential.
6. Old practice in medicine is the presentation of clinical cases. Noticing errors and commenting on them is essential. Criticism must be staunch. When discussing medical blunders, cronyism should be minimized.
7. Reporting errors is ethical. Covering them up is not. Making mistakes in medicine and looking for ways to solve it concerns medical ethics. Nowadays this attitude is uncommon. It deprives loyalty towards colleagues, towards the hospital, towards the economy – “you send me patients, I send you patients” – and towards pharmaceutical companies, not towards the truth.
8. Medical professionalism, “Unwritten contract between doctors and society whose purpose is to practice medicine with integrity, compassion and empathy…” must be strengthened. Professionalism adds self-criticism and ethics. Doctors attentive to criticism are self-critical; Self-critical doctors adhere to ethical principles.
9. Doctors’ loyalty should be to patients. There are no double standards.
Making mistakes in medicine is common. Mitigating errors depends on a self-critical attitude, knowing how to accept criticism, and having the ability to listen to patients and colleagues. Medical ethics are strengthened when these attitudes are added.
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