I'm So Sorry

I was actually told once that the letters "MD" mean never having to say you are sorry.  There is that stereotype that the public has.  That being a doctor means you are "less human" than others, that you make less mistakes, and that when errors do happen it wasn't the doctor's fault.  Like hearing Superman apologize for not being able to save a bystander from a flood or an exploding volcano...you never see him apologize in the comics for something that was actually HIS fault.  As doctors there is that idea, that somehow we are similar to this, but in my experience at least, I have found that I am still very much human and prone to the same errors of poor logic and dumb mistake that I was susceptible to before I became an MD.  I think I had this thought in the back of my head that when they handed me my diploma I would somehow change and instantly become this infallible super-human figure...but it's just like when they ask you if you feel any older on your birthday...you don't.

Even still, it's this feeling that you shouldn't apologize that I struggle with.  I think you could take the most kind and considerate person on the planet, place them in the shoes of a doctor, and even they would struggle with apologizing to a patient.   Every single time that I say the words "I'm sorry..." to a patient, my mind mentally pauses and I feel guilty.  I think the guilt stems from that idea that doctors don't apologize because doctors don't make mistakes and from the idea that I shouldn't have made the mistake period...maybe also a little bit because I feel like I'm opening myself up to litigation ;P (but really more for the latter reason).  You have this thought that when you admit to a mistake or an incorrect course of action that they will tear you apart, that they will fire you from their care, or that they will not trust you (and that may happen) but it won't happen near as fast as it does if you refuse to communicate with your patients and if you refuse to admit your mistakes to others.

I recently had to apologize because I hadn't communicated how poor a prognosis this little 12 year old girl under my care had.  I honestly just assumed they knew how bad it was and I let it catch them and me off guard when they realized that she was going to stay the way she was for possibly the rest of her life.  The girl who I speak of is an eleven year old who is currently bed bound from a infection of the brain that went untreated too long. The hospital received her from an Indian reservation where medical care was poor. She isn't improving, she won't be improving, she is actually getting worse.  The parents are frustrated, the medical plan is not changing, and my attending after discussing what our patient's course of care is likely to be (chronic, unremitting, dismal - seriously pick a word - the clinical prognosis SUCKS for this kid), with tears of frustration hanging in the mother's eyes his words are, "I can see that you are impatient mam, I can see the frustration in your eyes, but this is how it's probably going to be for your daughter for the foreseeable future."  He then coldly walks from the room without another word.  I then spent the next 40 minutes speaking with the parents and a lot of that speaking involved saying that I was sorry.  Sorry that we couldn't do more.  Sorry that I hadn't updated them frequently enough and that they had felt surprised by this statement of prognosis.  Sorry that their daughter is dying and there is little we can do.  I honestly admitted to them one of the reasons I hadn't spoken directly of her prognosis was because I didn't want to be the one to say it...which was more than a little true...I should have though, I knew them best.  Having me state the tell them in two words would have been better than what we had done to them just then. I let them down.

In horrible moments like this, moments even Supes could not bear, he would go back in time by flying around the world rediculously fast (like the movies), he'd go back, and give the child antibiotics and this little girl would be running around causing trouble with her friends present day...but she's not playing with her friends...she's laying there in a diaper, with a hole in her neck, and a tube in her stomach...she's laying there with an unblinking stare.  She and I share a terrible truth which the parents are now beginning to realize as well...there is no Superman, it's just me and all I have for them is my pathetic apologies.  I'm so sorry.

Newbie Doc