Sidnacius | 04 Apr 2008

Errors in journalism are a major cause of harm to public. Though there is little controversy among journalists about the importance of accurate and reliable data and the imperative of correct diagnosis that commitment to exactitude dissolves when errors h

Errors in journalism are a major cause of harm to public. Though there is little controversy among journalists about the importance of accurate and reliable data and the imperative of correct diagnosis that commitment to exactitude dissolves when errors happen. Then, journalists and editors may behave in a way that limits investigation. We often use the subjectivity and complexity of journalism to rationalize and justify errors but many factors explain this reluctance to investigate and to accept such errors. If we are to design effective systems to prevent errors from affecting patients, we must understand these factors. The following case study illustrates the concerns, fears, and practical problems that public faces in conducting an evaluation of misinterpreted news articles. It will also clear the misconception that blunders do not occur in countries other than ours, which we Indians believe to be a fact.
                                                     The problem and the decision
In February 1999, an urologist at the Sturdy Memorial Hospital in Attleboro, Massachusetts, requested a retrospective review of a 1996 biopsy result because of the patient's clinical course and the results of a biopsy in 1999. The review revealed that the 1996 report was incorrect. The urologist and pathologist (neither of whom was responsible for the 1996 reading) implemented appropriate management for the affected patient. When they discovered a second misread prostate biopsy from the same period the urologist and pathologist became concerned that the frequency of these errors was higher than “expected.” Fears about malpractice suits and damaged reputations emerged. The potential of a bigger problem meant risk to more patients but also greater risk to the physicians whether they confronted or ignored the problem. Were more patients at risk because of errors? If this was not addressed now but discovered later, would the risk of lawsuits and dishonour be greater? The clinicians sought the advice of the medical director. As a clinician, the medical director's instincts were to place the patients first and investigate the problem. As an administrator, he worried that even the suggestion of errors would damage the reputations of those involved before any investigation was completed. Those risks would be magnified if the media inflamed the story, and regulatory agencies had histories of being highly accusatory. The hospital board of managers might not support an investigation because of the bad publicity. An investigation might result in a colleague being disciplined for findings that might be controversial or even within the normal range. Ultimately, the medical director thought that all the prostate biopsies performed during 1995-7, the period of tenure of the clinicians associated with the two errors, should be reviewed. For this, the support of the hospital president was critical. The president also recognized the importance of addressing this issue for patients, physicians, hospital staff, and the community. Not being emotionally burdened by a belief in medical infallibility, the president felt less conflict than the clinicians about how to proceed: she worried about the impact of negative publicity, not least on the hospital's financial performance, but for her the only option was to ensure that no other patients were at risk.
                                                                    The review
In total 20 of the 279 prostate biopsies from 1995-7 were in error. The urologists caring for these 20 patients were told of the changes in the biopsy interpretations, and it was agreed that the urologists would contact each patient and recommend appropriate evaluation and treatment. Although they agreed with this plan, the urologists were worried about potential lawsuits, damage to their reputations, and the stress of difficult meetings with the patients and their families. Several meetings occurred between the medical director and the urologists to ensure that the follow up was occurring and to support the urologists. The medical director attended some of the meetings with patients. When the process of notifying the patients started, the hospital president realized that questions about the validity of other biopsies would be raised even though there was no clinical evidence to raise such concern. She thought that all should be reviewed. There was no precedent for such an extensive review. Moreover, in considering it, all the earlier dilemmas resurfaced. Some journalists weighed the risk of further negative publicity, the lack of standards for “acceptable rates of error,” costs, time required to complete the review, and lack of clinical indications to justify such a review. Finally, they decided to do the review to ensure no more patients were at risk and to affirm their commitment to patients. About 6000 biopsies would have to be reread and investigated thoroughly. Were they really interested in protecting patients or just exposing physicians? To do the review they wanted pathologists who were board certified and had extensive clinical experience, and they wanted to limit the number of reviewers to only a few. So they eventually contacted two pathologists, who were willing to help them only if they remained anonymous. Their project was apparently so controversial in pathology circles that they would not openly acknowledge that they were helping him.
                                            Communicating with our community
In the meantime the president and other senior managers were communicating with the medical staff, hospital staff, the board of managers, and the community at large. The public relations “nightmare” began when a potential plaintiff's attorney called the local newspaper. That resulted in an intense flurry of newspaper and television coverage. But instead of bringing the facts to the people, much of the coverage in the electronic media was inaccurate and inflammatory, and it became difficult to believe the electronic media. Reporters without medical expertise often unintentionally misled the public because of the complexities of the issues and the lack of time to understand and explain. Moreover, they seemed to believe wholeheartedly in the mythology of infallibility that professionals have promoted. Such an incident, I think should be communicated directly with our community which is our best communication strategy. The public should be respected and their confidence in the journalist fraternity should not be played with, by publishing such wrong news.
                                                        A positive experience
Why are we so reluctant to own up to errors in journalism? If we expect perfection, error is humiliating and potentially costly. But expecting perfection is foolish; we must move away from this false and unattainable standard. If we don't accept the inevitability of our own errors and those of everyone in the journalism fraternity we cannot honestly put public first. We also risk becoming the villains in the growing “mass awareness movement” instead of leaders in it. Such experience of admitting errors at Sturdy which I have tried my best to depict in this article has taught me at least, how positive an experience it can be.