For physicians, the prospect of disclosing serious medical errors to patients or their families is accompanied by threats of malpractice lawsuits, tarnished reputations and feelings of incompetence. All of these fears, says Emory medical ethicist John Banja, PhD, can push many doctors into the trap of what he calls "medical narcissism" - emotionally insulating themselves from the very persons they are duty bound to care for so as to ward off the psychological pain of being human and fallible.
Dr. Banja addresses the issue in his recently published book, Medical Errors and Medical Narcissism (Jones and Bartlett Publishers). He examines the concept of "medical narcissism" and how error disclosure to patients and families is often compromised by the health professional's need to preserve his or her self-esteem. The cost, Dr. Banja says, is the patient's right to the unvarnished truth, and the possibility of being sued.
In the book, Dr. Banja explores common psychological reactions that occur when a physician decides not to disclose medical errors. He offers insight on how capable individuals can feel such a driving need to demonstrate their competence that they fall into narcissistic traps.
"It's very difficult to call a foul on yourself," says Dr. Banja, a clinical ethicist at Emory University's Center For Ethics. "Most professionals work on cultivating a self that exudes control, knowledge and competency. But in the atmosphere of healthcare, physicians are expected to be errorless by their supervisors, and their patients expect them to be perfect."
Dr. Banja notes that malpractice carriers and hospital lawyers may encourage "medical narcissism" because they have long insisted that health professionals not admit or apologize for errors. Therefore when faced with disclosure, physicians often take another route.
"The most interesting thing I stumbled across in my research was the way health professionals rationalize not disclosing their medical errors," says Dr. Banja. Errors become 'misadventures' or 'incidents' or they are downplayed by saying that there isn't enough evidence to say the error caused the patient harm."
Legal literature on medical malpractice as well as anecdotal literature, Dr. Banja says, reveals the frequency with which health professionals become hyper-defensive, shift blame, or emotionally distance themselves when faced with medical errors.
Medical Errors and Medical Narcissism offers guidance on disclosing errors empathetically, even suggesting helpful words and phrases. Dr. Banja also suggests recommendations on tort reform, developing a "just culture" for reporting errors and instructional strategies for overcoming the narcissistic temptations in healthcare.
"We're finding out that disclosing error truthfully and honestly isn't only the ethical thing to do, but seems to be a very cost-effective strategy when weighed against the possibility of lawsuits," Dr. Banja says.
Dr. Banja is an assistant director for health sciences and clinical ethics for the Emory University Center for Ethics and an associate professor in the Department of Rehabilitation Medicine. He received a doctorate in philosophy from Fordham University in New York and maintains a specialty interest in moral issues associated with catastrophic neurological impairment. He teaches medical ethics at Emory and has authored or coauthored over 150 publications.
He has just concluded a research project funded by the Agency for Healthcare Research and Quality on examining communication strategies for health providers who encounter emotionally painful situations involving errors or unanticipated outcomes.