Medical Error: An Ethical Navigation of Physician’s Accountability

What constitutes a medical error and who is accountable for these errors? Following heart disease and cancer as a leading cause of death, medical error has significant impacts on both the patient and physician populations. In accordance with the Medical-Industrial Complex, healthcare institutions proceed to focus on profit to eliminate economic burdens and provide more opportunities for innovation, therefore, physicians become burdened by the overwhelming nature to meet the expectations of this profit. Likewise, patients have become significant advocates for their healthcare due to the access of the plethora of information in today’s world. In the end, doctors are overloaded by fulfilling the expectations of both their healthcare managers and their patients. While physicians are pressurized by these factors of modern medicine it can impact the quality of the care delivered and potentially result in an error. Consequently, it is essential to question, to what extent is it ethically permissible to hold physicians accountable for these errors?

Table of Contents 

• Abstract

• Introduction

• Background

• Roles and Process

• Impacts

• Analysis

• Ethical Considerations

• Conclusion

  
  

Introduction

According to a study completed by Johns Hopkins in 2016, medical error is the third leading cause of death in the United States. It is generally assumed that medical error only impacts patients. However, medical error has important implications for both doctors and patients. There are multiple facets of medical error, but in my paper I will focus specifically on doctor’s accountability. I will use the experience of contemporary medicine to demonstrate that the classic expectations for the physician-patient relationships have dramatically changed. Ultimately, this conflict leads to a conclusion in which doctors may not be fully accountable for medical errors.

What is today’s world of medicine? Shaped by the Medical Industrial Complex, “a large and growing network of private corporations engaged in the business of supplying health-care services to patients for a profit” (Relman), contemporary medicine is largely centered around generating the max amount of revenue. Therefore, it requires physicians to see as many patients as possible to produce this revenue. Constituting a less personal connection as in the past. Even though the forced approach to see as many patients as possible can depreciate connection, patients still withhold an expectation of a personalized patient-physician relationship. In my paper, I will call attention to the ways in which the assumption of this relationship in conflict with the Medical Industrial Complex should change the perspective on physician accountability. 

To begin, let’s summarize the facts. Today, Hospitals and doctors are regulated in a variety of ways. According to a 2017 American Hospital Association report entitled “Regulatory Overload,” hospitals are subject to more than 600 regulatory requirements. Specifically, Doctors are regulated by state licensing boards, hospital review boards, and medical malpractice litigation, to cite just a few examples (American Health Association). Under most circumstances, the error will result from adverse events such as errors in diagnosis, procedure, or communication that will be further described later on in my paper (Hipskind, Houseman, Rodziewicz, Vaqar). 

Simultaneously, a patient’s views of a physician’s responsibility are substantially shaped by the expectations of contemporary medicine. The Hippocratic Oath describes this relationship in what one would imagine to be the ideal patient-physician relationship: a one-on-one relationship between patient and physician, without intermediary parties. However, in a society where our healthcare system is ever-evolving, responsibilities for physicians have changed in many ways. Patients are guilty of expecting the physician, just as everything in the modern day, to be readily available at all times. Doctors are held by public opinion to the expectation of treating the patient under the terms of The Hippocratic Oath and the ideals of easy access, but this does take into account the terms of modern medicine.

Modern responsibility includes a larger variety of duties (multidisciplinary teams, technological advancements, etc.). Hospitals are more likely to have become businesses, clouding them from focusing on their patients. Therefore, the modern physician is conflicted between balancing responsibilities of traditional medicine under The Hippocratic Oath and fulfilling the needs of patients today.  

In my paper I will begin by giving background on medical errors. Then, I will reference The Hippocratic Oath and other evolving factors that contribute to medical errors in modern medical practice. Finally, I will analyze the impact on both doctors and patients through the consequentialist framework and the ethical values of transparency, accountability, and fairness. Throughout the paper it is imperative to keep these ethical questions in mind: Should physicians be held accountable based on a vision of professionalism that assumes a dyadic relationship? Should we lack trust in our doctors if they are no longer considered accountable based on the Hippocratic Oath? To what extent is it ethically permissible to hold physicians accountable for medical error?

Background

Before analyzing the consequences, roles, and allocated accountability, it is essential to understand the meaning of medical error, who it applies to, and examples of it. According to Ethan D. Grober and John M.A. Bohnen in “Defining Medical Error,” medical error is described as “deviations from the standard of care or preventable adverse effects that may or may not cause harm to the patient” and as a general matter, medical errors can be allocated to one of two main categories: errors of omission (result of actions that were not taken) or errors of commission (result of the wrong actions taken). This is a broad definition and could encompass many different types of medical incidents as error (Grober). 

Typically included in the range of errors are inaccurate diagnosis, errors in technology, and communication errors. To begin, inaccurate diagnoses are an extremely common form of medical error. In fact, the Joint Commission states, “one patient in every six could be a victim of diagnostic errors.” Misdiagnosis may occur as a result of failure to order appropriate tests, failure to follow up, and failure to refer. These errors most commonly occur in solo practices where physicians are less likely to cross reference the diagnosis with other medical professionals. In other instances, it can be difficult for patients to receive a second opinion or diagnosis to confirm their illness due to barriers such as location, finances, and awareness. The most common illnesses associated with misdiagnosis include, cardiac, cancer, and neurological diseases. Further these diseases have potential to result in death and the failure to accurately diagnose these patients could result in serious conditions, including death (Rodziewicz, Houseman, Vaqar, Hipskind). 

A second common form of medical error involves failures of equipment. While using sophisticated equipment that promotes efficiency and quality has potential to save more lives, there are equipment failures that can result in adverse events or vice versa, an adverse event can result in equipment failures. Equipment failures are not always medical errors. However, equipment failures are considered medical errors when the machine fails due to inadequate maintenance, faulty planning, and inaccurate use of equipment. These adverse events are forms of preventable circumstances, qualifying them as medical errors (Rodziewicz, Houseman, Vaqar, Hipskind).

In a study completed by the Joint Commission in 2012, it was found that communication during patient hand-off contributes to 80% of medical error (Joint Commission International). Communication breakdowns can occur when using technology and in verbal communication. Information technology, such as electronic health records, have the most potential for errors. Many healthcare institutions use the electronic health record system to enable communication between practitioners and with their patients. Entering information into these systems can become complex and physicians risk accidentally entering false information resulting in inaccurate patient documentation. Electronic records are also prone to errors such as internet failure or device malfunctions that similarly put patient documentation and communication at risk. Secondly, verbal communication can easily result in miscommunication. Some causes of verbal miscommunication resulting in error include the time pressure, inability to collaborate, language barriers, and more. In most cases, these errors are as a result of a failure to communicate between physicians, but other times it is a failure to communicate with patients and their families (Hipskind, Houseman, Rodziewicz, Vaqar). 

In the end, medical errors are not listed as the cause of death on death certificates. Therefore, it is difficult to detect whether or not there was medical error at play. Instead, the medical condition that led to the patient’s death is on the death certificate. This ultimately leads to skewed statistical information and difficulty to accurately measure the number of medical errors and the types of errors that could have occurred. Instead, data includes surveying licensing boards and medical malpractice insurance to gauge the approximate statistics on medical errors. Additionally, locating information on previous judicial opinions and reports on previous malpractice cases is beneficial in seeking accurate data (Johnson, Johnson, Lucas, and Middleton). 

Understanding the factors contributing to medical error is essential to analyzing the facets of attributed accountability. Moreover, some of these errors may not be purely by one doctor’s mistake and it is essential to reassess the allocated accountability. Likewise, as I describe the role of the healthcare system and the physician it is crucial to keep these examples in mind. 

Roles and Process

Now, let’s begin with the question: What is the purpose of the doctor and what role does the doctor play in society? How does their role change the way we should hold them accountable for medical error? A doctor’s job includes much more than just “saving a life.” In fact, as they are the patient’s advocate their job includes providing comfort, support, and defense during diagnosis and treatment. According to the Center for Health Interprofessional Practice and Medicine at the University of Texas, it is of equal importance that physicians find “the patient the most patient-centered care in the most cost-effective manner” (“Physician Role”). Furthermore, the physician should provide assistance to the patient in navigating the complex world of medicine.

Given their highly regarded duty to provide the utmost quality of care, it is essential to have a variety of regulatory frameworks that apply to doctors. An oath, institutional policies, professional society, codes of ethics, licensing standards, and negligence law individually and collectively hold doctors to a standard of care. 

Although, the Hippocratic Oath, is separate from other regulatory frameworks. The Hippocratic Oath has been a custom since 400 BC. Yet it only debuted as the universal oath in the 19th-century. The original oath, attributed to Hippocrates, binds doctors to treating the patient to the best of their ability and judgment (Indla). The oath even states itself that the physician, “will observe and keep this underwritten oath, to the utmost of [their] power and judgment” (Hippocratic Oath). Since it began long ago, it was a pledge made to do best when healthcare was centered solely around one patient and one physician. Therefore, when should we consider what is out of the power and judgment of the physician? 

As times change, society should still expect physicians to adhere to an oath, however, it must be assured that the standards of the oath are still obtainable in contemporary medicine. In a survey completed by 2600 physicians in 2017, it was confirmed that 34% had voted that The Hippocratic Oath has led to their physician burnout (Medscape National Physician Burnout and Depression Report). The Hippocratic Oath prioritizes patients’ needs before the physicians’ needs. Obviously the patient’s health is always the chief concern, but we should consider ways to live in a society where we no longer put a doctor’s health (emotional and physical) at the cost of a patient’s needs. An excerpt from the oath states, “may I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help” (qtd. in Hippocratic Oath).

Demonstrated in this quote, the physician's joy would come from saving the lives of those who need to be saved. Yet, today, more often than not the joy becomes harder to fulfill as physicians are struggling to meet the expectations of both their patients and the practices that they work for (Grimes). 

In conclusion, the role of the doctor has many aspects and a doctor is responsible for fulfilling the expectations of various groups. In terms of medical error, when allocating accountability to physicians, thoughts should return to their original roles and expectations. Are these expectations limiting them from doing their best work? Are they able to fulfill their duties as a doctor in today’s complex world of medicine? 

Impacts

There are a variety of ways that medical errors can come to light. The doctor may suspect or know that the error has occurred, and inform the patient or the patient's next of kin. In contrast, the patient or patient's next of kin may suspect or know that an error has occurred and may inform the doctor, the doctor's staff, or, if applicable, hospital personnel. Other ways errors arise include members of the care team who believe or suspect there has been an error. In addition, if the patient knows of or suspects medical error they could inform their attorney. Due to this, at times, the first notice the doctor, doctor’s staff and/or the hospital may receive is a litigation complaint that is served on them by the patient’s attorney. Some might say litigation begins when a party first consults counsel; others might say it begins when the complaint is served on the doctor. The doctor may not have counsel when they are served, but they are definitely involved in litigation from that point forward. 

Currently, when the hospital is aware of the medical error, the hospitals practice a Root Cause Analysis (RCA) to document the error and understand the individuals involved. The RCA immediately begins after the healthcare institution is notified of the error. An RCA typically focuses on the systemic processes of the institution and later on, proposes an action plan to address and prevent the problem from happening again. Failure Mode Effect Analysis uses repetition in reporting of error to use as a process of identifying the most common errors and a more proactive process of identifying the errors (Hipskind, Houseman, Rodziewicz, Vaqar). These processes are effective in analyzing the reason for the error occurring, however they often overlook the underlying systemic issue of why the error took place.  

There are four main elements of a cause of action for medical malpractice. The plaintiff has to show that there is an applicable standard of care, that the doctor violated that standard of care, that the breach was the proximate cause of the plaintiff’s injuries/damage, and that the plaintiff has experienced legally compensable injuries as a result of the defendant’s breach of their duty to the plaintiff (Bal). 

If it is found that the physician violated a variety of legal responsibilities, it will be followed by a form of consequence or disciplinary action. The most common form of disciplinary action is the financial burden of the lawsuit and of malpractice insurance (Sigelman). Typically, malpractice litigation could take up to two years to begin, but hospital or administrative disciplinary processes may begin immediately. If an adverse verdict is publicized, this can diminish the reputation of the physician. Other times, these cases are not made public and reputations are not impacted. Only under extreme circumstances does a doctor lose their license or face criminal prosecution. Nevertheless, doctors face the potential mental repercussions of these situations, which can result in an inability to provide the same level of care.  

Comparably, the harms that patients can experience may include but not necessarily be limited to: physical injury, emotional distress, lost income, costs of corrective treatment, and loss of trust in doctors or in the healthcare system. 

In conclusion, medical errors can have severe impacts on careers. Discipline for the doctor is taken very seriously. In terms of accountability, it is essential to recognize that if accountability is placed on the doctor the holistic evaluation is important in determining all aspects of who should be disciplined. 

Analysis

To begin my analysis of medical error and the importance of questioning accountability attributed to physicians during malpractice based upon the complex of today, it is significant to acknowledge the ways in which healthcare institutions today differ from healthcare institutions of the past. 

Hospital environments greatly impact the quality of care provided to patients. To begin, hospitals are overwhelmed. Just to surface the issue, doctors are provided a limited amount of time to meet with their patients which causes them to have a limited gauge of the necessary treatment plan. While it is important to recognize that different specialties spend different amounts of time with their patients. According to the Medscape Physician Compensation Report completed in 2017, it was suggested that overall 30% of physicians spend 17-24 minutes with each of their patients and 29% of physicians spend 13-16 minutes with their patients. So nearly 60% of doctors spend about 15 minutes or more with their patients. To some, this could be seen as a large amount of time, but in reality this time is limiting and does not provide doctors with the opportunity to form a meaningful relationship with their patients. 

Not only does the limited time frame impact patients, but also the employment of the hospitals. Instead of patients being seen by their primary care physician, there are more times than not when patients are seen by a nurse practitioner or a physician’s assistant. In fact, according to a study completed by the BMJ (British Medical Association), the number of U.S. healthcare visits delivered by non-physicians such as nurse practitioners or physician assistants increased from 14 to 26 percent from 2013 to 2019. As it is easier to fill the demand for nurse practitioners and physician’s assistants, many healthcare institutions will see a rise in these professionals vs. physicians. It is not concluded that the quality of care delivered by these professionals is inadequate, however, different treatments and procedures are best suited for different professionals and, at times, that professional is the physician (Auerbach, Barnett, Frakt, Huskamp, Neprash, Patel). 

Simultaneously, Between 2019 and 2022, hospital expenses increased by 17.5% (American Hospital Association). Therefore, hospital institutions are to increase in productivity to support the even busier system. Due to the economic burdens faced by all healthcare institutions, doctors are required to treat more patients in order to offset the increased expenses (taxes, profit reductions, and costly resources) faced by the healthcare institutions. This aspect of the Medical Industrial Complex that drives profit does not directly cause medical error, but it forces doctors to work with a different approach and with a mindset that no longer prioritizes the patients. Rather, it prioritizes the quantity of patients to increase revenue. As doctors continue to see more patients a greater probability of failing to provide appropriate care to a patient becomes increasingly likely. Lastly, the more patients seen, the less amount of energy the physicians have at the end of the day. These long work shifts produce heavy amounts of fatigue and result in the possibility of failure at providing the best quality of care to their patients. 

As society is exposed to greater information regarding healthcare testing, illness, and symptoms, patients are more likely to develop a fear of a major condition (Swan). Therefore, patients are more likely to schedule unnecessary appointments and tests. This increases the high demand for physicians and it now takes weeks to get an appointment with a primary care doctor and months for a specialist. As a result, physicians are then held to tough schedules not only by the healthcare institutions, but also by patient demand (Harvard Medical School). Consequently, the patient demand increases the already busy schedule and further overwhelms the hospitals. 

Next, the hierarchy of healthcare institutions suggests there are practices that are associated with different rankings of roles in a healthcare system. For example, the role and responsibilities of the attending physician are different from that of the resident. As their background includes more experience, such as being board-certified and already completing their required residency, the attending obtains the responsibility of supervising the residents who are assigned to them. As a result, the attending is generally considered responsible for the actions of the residents and interns. As stated before, the overwhelming nature of the hospitals serves as a distraction for the attendees and allows them to lose sight of the residents and physicians they are responsible for. Therefore, a situation of disconnection between the healthcare hierarchy could provide potential for an error. 

In most medical schools, education about medical error is integrated into the curriculum for third year medical students. These forms of education include, but are not limited to, interactive discussions, readings, and simulations. First and foremost, medical schools and healthcare institutions prioritize teaching patient safety in addition to focusing on disclosing the errors and becoming comfortable with completely disclosing all aspects of error with the patient. Centering the curriculum on response to patient emotion and displaying an empathetic nature could greatly improve the result for more patients (Gohal). However, as the Medical Education and Societal Needs: A planning Report for the Health Professions states, “The multiplicity of changes and trends in health care and the interrelationships of these trends severely complicate any projections of future requirements for medical education” (Williams, Nightingale, Filner). Simply, it is essential to address that as The Medical Industrial Complex becomes more complex, the educational practices for physicians should be simultaneously refined. 

To summarize, the analysis of physician accountability and medical error begins with acknowledging the evolution of healthcare institutions. Contemporary medicine is faced with combating challenges that impact quality of care as mentioned before. Healthcare has become more focused on quantity over quality, heightening the risk and frequency of medical errors. 

Case Study

When beginning my research, I came across a niche however frequent example in which private equities take over healthcare entities under the impression that these institutions will boost profits. This example accurately depicts a circumstance in which a healthcare institution evolves and the physicians are ultimately impacted by this shift. In a study published by JAMA in December of 2023 it was found that three years after any private equity fund bought a hospital there was a 38% increase in central line infections and a 25% increase in surgical infections among Medicare patients from hospitals that are owned by private equities (Abelson, Sanger-Katz). Even though it is difficult to correlate these statistics directly to medical error, it is true that the resource cuts to increase profits can have severe impacts on the quality of care delivered to patients. All hospitals want to earn a profit, however, this is significant and in this instance, the motive of the hospital management would not be to save lives, but to increase their profits as a business. When motives are shifted, there are other influences on the dynamic of the patient-physician relationship. The accountability held to the doctor should be reconsidered and it is crucial to develop reasoning as to why an infection/error may have occurred. Likewise, in order to boost profit the hospital must improve in some way. Consequently, the physicians are then held to unobtainable high standards to fulfill the revenue needs of the hospital. Given this example where the process of the system drives the physician to misstep and make an error, we consider to what extent is it ethical to hold physicians accountable for these errors when it is management igniting the complexity resulting in adverse effects?

Ethical Considerations

Who are the stakeholders? 

When a medical error occurs there are groups that are directly and indirectly affected by the error. For example, physicians and patients are obviously impacted. However, healthcare institutions, malpractice insurance, professional associations, and regulatory agencies are likewise affected when a medical error occurs. These secondary groups change based on quantitative forms of data that arise in terms of medical errors. When errors rise in frequency, it results in these agencies shifting protocol. 

Transparency

The value I will begin with is transparency, specifically the role of an apology. I will be exploring the impact of an apology in terms of recognizing accountability. It is a legal responsibility that the physician lets the patient know the implications of the care, the post-op impact and more. In healthcare, transparency is most commonly associated with informed consent and providing the patients with all options regarding the most productive and cost-effective treatment (AMA Code of Medical Ethics). However, transparency is just as important after the procedure and treatment as it is during and before the treatment. In terms of a medical malpractice, this often includes making a judgment on the approach of the physician's apology and the ways in which the doctor was transparent after the fact. In an error disclosure study it was reported that only 47% of surgeons are likely to have some form of an apology towards the patients (National Institute of Health). Given that only 47% of physicians were likely to disclose the error, this leaves the majority (53%) of physicians less likely to report the error through the form of an apology. 

On one hand, an apology means they are demonstrating sympathy in that they "feel" for the patient’s emotions and are owning up to the error. Simultaneously, the physician is communicating regret for having caused such harm. Some might say that an apology conveys respect for the patient as well as the physician’s humility. In many cases, this can decrease patient anger/the emotions they feel towards the doctor who has made the error. An apology aligns with the ethics of the medical profession and could increase the likelihood of the physician continuing care due to the respect that comes from an apology. But many still may question, why may a physician refrain from apologizing? 

One reason for failures to apologize might be that the doctor is confessing that a serious action has occurred and this can cause damage to the patient-physician relationship. Similarly, many physicians are fearful of their words ultimately being used against them, and they fear that there words will be used against them in court. As previously mentioned, the various pressures of the healthcare system influence the doctor in a way that can cause them to make an error. Take for example the communication breakdowns from electronic health records. As this form of communication is relatively new to healthcare, it has not yet been predetermined who is at fault for the error in patient hand-off through communication breakdown. Therefore, when the doctor apologizes they could be owning up to a mistake that is directly a result of their actions. Given that an apology and the role of the doctor requires them to own up to mistakes, I believe that doctors should have to own up to their mistakes but it is important that there is patient education on the variety of factors that could result in an error because they will then be more likely to withhold empathy for their physicians. Rather than quickly asserting blame on their physicians, patients will then holistically understand that the Medical Industrial Complex is overwhelming for physicians, and could holistically cause a physician to make a mistake. 

Accountability

The second value that I am going to discuss is accountability. An overarching theme to my paper is that there are many variations of perspectives on accountability. We can consider accountability to rely on responsibility, as an intertwined approach. Furthermore, accountability is how one accepts the consequences of failure to fulfill their responsibilities. In terms of medical error, this would mean how doctors are accountable for an error after it has occurred, rather than their responsibility throughout the medical procedure. Doctors must uphold their role and be held liable for their actions, however, it is important to consider the extent to which physicians should be held accountable. 

One could argue that doctors are the ones completing these actions and ultimately executing these errors, in which case holding them accountable is just. It is a doctor's job to deliver the best quality of care and prioritize the patient. And as mentioned earlier, under the Hippocratic Oath, doctors are pledging to deliver this experience. Therefore, they would deduce that they should be held accountable when appropriate care fails to be delivered. 

Others could argue that if doctors are held accountable to a great extent, they will be reluctant to be honest about their errors in the future for fear of consequences. As a result, doctors are less likely to own up to their mistakes. Holding doctors accountable forces them to develop a fear of the potential consequences. If doctors are fearful of the consequences they are less likely to make a mistake. 

To summarize, if doctors are significantly penalized, they will not want to be honest about their mistakes. However, the risk of significant penalties will make them more careful/less likely to make mistakes. Should we be willing to live with doctors being more careful but less transparent? 

Given these ideals and the analysis of the standards for doctors, I believe the extent to which physicians are held accountable should be taken through a more holistic approach and the Medical Industrial Complex should work to eliminate the systemic issues that can result in an error. A variety of measures can be taken into consideration for there to be an effective approach. For example, “Just Culture” is an initiative that incorporates a system of shared accountability throughout healthcare organizations. As a result, employees are held accountable for the quality of their choices, and for reporting errors and system vulnerabilities. At Brigham and Women’s Faulkner Hospital, “Just Culture” has caused doctors to feel more comfortable with reporting errors knowing that the consequence is not to punish. Paul LeSage, the Just Culture Advisor with SG collaborative Solutions, LLC, says “this approach is about looking for risk not fault” (Mass General Brigham). For me, I see this as an opportunity for hospitals to both improve the pressures on physicians, while also securing patient safety by encouraging professionals to feel more comfortable in disclosing errors and potentially unsafe or suboptimal conditions that could result in errors. 

Fairness 

Is it fair to hold doctors accountable to uphold the standards of the Hippocratic Oath when they are challenged by systemic issues that may be beyond their control? Circling back to the instances of the ways that our healthcare system has changed today we must question, what are the new standards physicians should be held to, and should society continue to hold them to standards of the oath? 

To question this, we must consider why the Hippocratic Oath has been a custom since 400 B.C.. Vishal Indla and M.S. Radhika contemplate The Hippocratic Oath vs. the Bioethics Principles of today in their report, “Hippocratic oath: Losing Relevance in Today’s World” that states:

When the oath was formulated, there existed only a tripartite relationship in medicine: between the patient, physician, and illness. This harmony was disrupted by the advent of health insurance, malpractice issues, technology, and pharmaceutical companies. The recent increase in government regulation, the proliferation of the third-payer system, and the democratization of medical knowledge all place pressures on physicians that are new to the last 40 years; their ethical implications are not satisfactorily addressed by the modern Hippocratic oath. (Indla and Radhika) 

In accordance with this analysis and the principle that mistakes happen, errors are always going to occur. In contrast, not everything about the Hippocratic Oath is outdated and there have been reformed versions to account for the evolution of healthcare. Likewise, in many ways it speaks to the importance of confidentiality, not taking advantage of patients or family members, exercising care or caution in providing care/not providing advice beyond the scope of the physician’s knowledge or practice.  

In conclusion, given that the Hippocratic Oath provides a guideline for doctors in the ways they should go about their patient-physician relationship, I believe it is fair to hold them accountable based upon the oath. Regardless, it is important that the oath expands to include other intermediary parties to adapt and account for the holistic approaches to medicine.

Consequentialism

To further analyze my ethical question I chose the framework of consequentialism. Consequentialism judges the ethicality of an act by examining its consequences. 

One potential adverse consequence of holding physicians to unreasonably high standards or making them accountable for circumstances beyond their control is that fewer people may choose to become doctors. Today, we are already experiencing a shortage in physicians, which James Taylor, President of the leadership solutions division at AMN Healthcare, describes as “a public health crisis.” If medical errors due to the pressures of the Medical Industrial Complex result in errors, more physicians are going to want to refrain from becoming physicians. The United States must still work to promote professions in medicine rather than give reasons to refrain.

On the other hand, failing to hold doctors appropriately responsible for medical error could lead to a lack of accountability and an increase in professional misconduct. The idea being, if people are not disciplined they will not self-regulate according to the set standards. This could potentially result in an increase in careless patient priority because there is not a risk of being sued for error. Consequently, the healthcare institutions would not be filled with professionals who devoted their responsibilities to protect the patient to the level they would if the discipline was greater. 

As medical error is just behind heart disease and cancer in its death frequency, it is important to consider both the patients and physicians that are impacted by these high statistics. If doctors are not held accountable, it seems as though we are risking a perpetual cycle of medical errors to occur. However, when they are held to extremely high standards society could face a decrease in physicians and a lack of trust within healthcare providers. Therefore, I believe there should be an extent to which physicians are held accountable, but we should reevaluate that extent as doctors face too many potential burdens due to the error. 

Concluding Thoughts

In conclusion, medical errors are always going to occur, mistakes happen, however we should consider whether physicians are taking on the holistic burden of accountability for systemic issues and for errors that are not a result of their direct actions. Therefore, in order to reduce the likelihood of medical errors there are a series of steps the Medical Industrial Complex can holistically take. 

After analyzing the role of the physician, standards for physicians, the healthcare system of today, and most importantly, medical errors, I have come to the conclusion that the extent to which we hold physicians accountable is limited in its ethical permissibility. Modern healthcare institutions differ significantly from those in the past, impacting the quality of care through overwhelmed hospital environments and lack of connection between the patient and the physician. The increased reliance on nurses and physicians amidst rising expenses for care, pressures the doctors to focus on the quantity of their work rather than the quality, heightening the risk of a medical error. Therefore, under these conditions of contemporary medicine, doctors face too much of a burden causing there errors that it no longer is ethical to hold them accountable. 

It is also important to address the root cause of the errors in addition to the doctor. If the complex system changes so that physicians are no longer burdened by the overwhelming nature, then there could be a more qualified system in which accountability is attributed when a medical error occurs. As mentioned earlier, treatment plans and procedures involve much more than just the physician and the patient and therefore those entities–healthcare institutions–should also be held accountable to a greater extent. 

In the end I would like you to think back to a question I asked in the very beginning of the paper: What is today’s world of medicine? And I would like for you to put this into the context of your everyday life when you go to the doctor. What does a visit look like for me? Am I treated the way I would like to be treated? Is my physician spending enough time with me? Does my physician look stressed out? These are all questions you can consider and then think back to this paper, if an error were to occur, would it really be my doctor’s fault? 

Works Cited