Caring for a Patient Means Being Able to Say You’re Sorry

Posted on | May 9, 2007 | Comments Off on Caring for a Patient Means Being Able to Say You’re Sorry

Over the decades, I’ve developed a bias that we doctors are fast to say what we know, slow to say what we don’t know, and overly comfortable with 180 degree reversals on prior opinions without so much as a “Sorry! We got this one wrong.”

When we’re right, the results can be dramatic. Take our efforts to control heart disease worldwide. A recent JAMA study of more than 44,000 patients in the U.S., Canada, Europe and South America from 1999 to 2006, showed that following guidelines established in 2001 by the American Heart Association significantly decreased deaths from heart attack. The use of aspirin, statins, clot-busters and timely interventions were all validated as useful. Congrats to us!

On the flip side, take a look at Hormone Replacement Therapy (HRT). Not only has the medical community changed its tune, but we’re still fighting among ourselves about it and seeding ongoing confusion. This, as breast cancer rates fell sharply in 2003 and 2004. In just the 18 months between July 2002 and December 2003, rates dropped 15%. In 2003 and 2004, rates dropped again by 10%. The drops involved women over 50, and nearly all the decline was in estrogen-dependent cancers.

Dial back to July 2002 when a large federal study to see if HRT decreased risk of heart attack in women (the Women’s Health Initiative) was halted because women had more heart attacks, not fewer. The HRT used in the study was Prempro, the most popular HRT for menopause symptoms. On the announcement, use of the drug for menopause dropped 50% immediately.

Dr. Donald Berry led the study out of M.D. Anderson Cancer Center in Houston. He says the surprise was the result of “statistical sleuthing.” And he’s put 2 and 2 together. The drop in HRT is directly connected to the drop in breast cancer rates. Cause and effect? Says Dr. Berry, “Of course, we’re not sure. We never are. But it fits. It’s a smoking gun.”

I don’t think “the people” expect “the people taking care of the people” to be right all the time. But I do believe doctors and others should more often replace hyperbole with humility. Caring for your patient means always being able to say you’re sorry.