by Mario Iannucci
23 LUG – Dear Director,
I read with great interest the article published on July 20, 2021 by Thalia Margalit Krakower on JAMA[1]. I also appreciated most of the arguments expressed in that article, in which the author, an Assistant Professor of Medicine at Massachusetts General Hospital, told us about the “agony”[2] suffered, for at least five months, by her six-year-old child.
The boy was eventually diagnosed with a rare form of brain tumor. After that diagnosis, the treatment seems to have headed in the right direction and we all hope that the little one is healed or is about to do so. During the first five months of the illness, however, the child’s ailments continued because, at the beginning, the doctors who treated him, including the primary care pediatrician, proposed incorrect diagnostic hypotheses, which led the further ones astray. diagnostic tests and therapy.
Thalia Margalit Krakower, who defines herself as a patient on this occasion (fully entitled, being the mother of a very young minor), would have very much wished that the doctors who had posed the hypotheses misdiagnosed had admitted their mistakes and offered their apologies. Only the basic pediatrician did it and, when she acknowledged the mistakes and apologized for them, she regained the esteem and appreciation of the child’s parents. In her article, Dr. Krakower explained to us the very good and undeniable reasons why it is essential for a doctor to admit the mistake and apologize.
We agree perfectly with the mother-colleague. We also believe that the accountability implicit in acknowledging a mistake is an integral part of the medical profession. We also believe that the importance of this recognition should be reported and taught with due emphasis in university teaching of all health professions.
Those who are unable to recognize their mistakes cannot be trusted: those errors will not be amended, they will probably be repeated and no moral compensation can be given to those who have suffered the damage. As a doctor, in my now long career, I have made some mistakes (very few, fortunately). I have always recognized them, trying to treasure those mistakes and participate in the pain of my patients and their families.
So I can only agree with many of the statements made by the author of the article. However, I would like to address some observations to the injured mother, considering that Thalia Krakower is a doctor and is as a doctor who publishes an article on JAMA.
The first consideration is this. Thalia Krakower says she was hurt by the embarrassed hesitation of the doctors who made a mistake, their inability to recognize the mistake and their lack of apology. I do not understand why Thalia Krakower marvels at this apparent inability to recognize the medical error on the part of colleagues. We live in an age in which, faced with a medical error, there are swarms of lawyers willing to sponsor cases for millionaire compensation.
Admitting to have made a mistake, during a phone call or a direct interview, with the risk of being registered, for those Colleagues would constitute a “fatal” admission of malpractice. Only the pediatrician, who for years had a consolidated relationship of knowledge and esteem with the child’s parents, thought she could admit her mistakes with them: she perhaps calculated that the attempt to recover a relationship of trust and friendship with them people were worth much more than the risk of a lawsuit.
The second consideration is the following. Thalia Margalit Krakower develops her arguments (which can also be shared) starting from a double position. From the position of mother of her little child who suffered a terrible “agony” for at least five months and, at the same time, from the position of doctor. The first position authorizes her, having been patient together and in place of the child, to apologize from the doctors who have misdiagnosed. The second position, however, given that you are a doctor and associate professor of medicine, would seem to make it appropriate for all the considerations you develop in your article to be credible, including your apologies. Apologies to his little son and other family members.
It is very true that not only is it not right for a doctor to take care of the health of a family member and that it is not even appropriate. It is equally true that the suffering of a person dear to us inevitably clouds our ability to reason correctly. But, after all, for five months Thalia Margalit Krakower, doctor, shared a wrong diagnostic setting and this, we suppose, is sorry for her as we are very sorry too.
Mario Iannucci
Psychoanalyst psychiatrist
Mental Health Expert applied to Law
Note:
https://jamanetwork.com/journals/jama/fullarticle/2782182
[2]This is the term used by Colleague Krakower. I left it in English, because in Italian it can be translated both with “agony” and with “torment”, “unspeakable pain”. Perhaps, considering the epilogue of the story described by Thalia Krakower, it would have been better to use the last two Italian terms, but I preferred to leave “agony”. We will understand why.
July 23, 2021
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