The financial and personal ramifications that come when a doctor apologizes to a patient:
In one case I still think about, Andy (I've changed his name to protect his privacy) was a healthy teenager with migraines. "Take 600 milligrams of ibuprofen to start, and if that doesn't work, I'll prescribe something else," I told him. But in the month that followed, Andy's headaches grew worse.
I found nothing abnormal when I examined him. When I reviewed his records, I noted that he was taking anxiety medication prescribed by a psychiatrist. Perhaps that could be causing his symptoms, I thought, so I referred him back to psychiatry and to a neurologist before sending him home.
The next morning, I received a message from the emergency room. After his appointment, Andy had had a seizure in a store. In the emergency room, a doctor noticed something important when he looked at Andy's eyes with an ophthalmoscope: swelling of the optic disc, located in the back of the eye. Papilledema, as it is called, is a cardinal sign of increased pressure inside of the head. Had I seen it, I would have done exactly what the E.R. doctor did—ordered a stat CT scan, which revealed that Andy had deposits of fluid in his brain. Had it worsened, the pressure could have caused Andy's brain to herniate down into his spinal cord, which may have killed him. When I had examined Andy's eyes the same way, I missed the papilledema.
There are at least 25 definitions of the word error in medical literature. But the regret, fear, shame, and self-loathing I felt were all the definition I needed. How could I have done this?