By Margaret Woon Man Fok, MD

Trust between a patient and a doctor can be very delicate. It can be broken by one unintentional clinical misjudgment. Once broken, it can take a long time to rebuild trust that patients have in their clinicians. 

Recently, I came across a case from one of my juniors: The patient was admitted following a fall on duty and the chief complaint was elbow and shoulder pain, but a subclinical scaphoid fracture was missed on the initial assessment. Upon follow up, the patient complained of wrist pain on exertion and was investigated with a radiograph of the affected wrist. The X-ray showed no obvious fracture and the patient was advised to resume work as he had already received 6 months of rehabilitation. Due to the persisted pain, the patient went on to see a private practitioner who had organised a CT scan that showed an undisplaced scaphoid fracture with non-union.

The patient filed a formal complaint against the hospital, and I was asked to manage his case. I remember that during the initial consultation there was a lot of mistrust and anger directed at me. He felt that we didn’t care about his condition and inappropriately encouraged him to resume work. To further complicate the matter, I had to explain to the patient that the outcome of treating an established scaphoid non-union could never be guaranteed. A further few months of rehabilitation is also required, which would have an impact on his life.

When faced with such situation, it is better to acknowledge the clinical error and try to reassure the patient that we will thrive to do our best to improve their condition. Instead of making excuses and blaming others, we need to focus on why the clinical misjudgment occurred and how we can improve our practice in the future. We need to explain the condition and treatment to the patient with up-to-date, evidence-based medicine after doing a comprehensive literature review. Furthermore, we also need to manage the patient’s expectation following treatment.

In the patients’ point of view, they have entrusted their well-being to a doctor. Patients often express disappointment and frustration towards their clinicians when they feel they have received sub-optimal care. Patients usually accept doctors are not perfect and can make mistakes. However, most will not accept a clinician who will try to cover their mistakes and make excuses. People generally appreciate honesty and are willing to give forgiveness. Like my patient, for example, who suffered from a missed scaphoid fracture complicated with non-union–after many lengthy consultations and discussions on various methods of treatment, a rapport was finally built. An arthroscopic bone graft was performed and the patient made a good recovery.

The days of patients blindly relying on their clinicians for treating their illness are over. With the vast amount of information and opinions available on the internet, doctors can often feel that they are being challenged and are not trusted by their patients. Yet, if we can keep an open mind, listen to our patients’ concerns and share with them our decision-making process, we will have many grateful patients in our career.