Elton John had it right: “It’s sad, so sad.  Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”

Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?

Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double shift, mistakenly writes the vincristine daily for 5 days similar to the prednisone order. The fatal dosage is given to the patient over the ensuing days. He dies in bone marrow failure.  The oncologist met with the family and apologized.  A review was carried out.  Systems were improved.  There was no lawsuit.

Example 2: In a radiology department, a cleaning solution rather than a dye is accidentally injected into a patient’s femoral artery leading to a painful death.  The hospital representatives and physicians promptly met with the family, admitted a mistake, apologized, and a financial settlement was offered and eventually accepted.

Example 3: A pharmacist fills a prescription for a patient with asthma. Instead of prednisone, the pharmacist mistakenly counts out digoxin, a pill given for heart disease. Digoxin can have severe side effects even at a dosage of one a day. The prescription is followed by the patient: take 8 a day for 3 days, 6 a day for 3 days, etc. The patient calls the MD about the symptoms of severe nausea and notes the pills look different than usual. The medication is stopped and with treatment the patient luckily survives digoxin poisoning.  No apology was forthcoming and the patient lost confidence in the integrity of his providers.

Medical errors frequently hit the headlines. Magazine articles, such as “How the American Health Care System Killed My Father,” can be both thought provoking, and provocatively accusatory. Stress and fatigue often play a role.

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