In medicine, be wary of "misspeakers"
who "shoot from the hip"
From the November 29, 2000 issue
PROBLEM: Have you ever been tempted to answer a question
even though you were not sure your answer was correct? Such
occurrences in healthcare are more common than we would like
to admit. Earlier this year, one of the editors of The Nurse
Practitioner encountered several instances of "misspeaking"
from healthcare providers who felt a need to say something
authoritative, despite their lack of knowledge on the issue.
1 While camping, the editor was bitten by
a bat. A 911 medical dispatcher who was unfamiliar with this
rare occurrence "misspoke" and told her that treatment was
not necessary. But the editor had recently published an article
on rabies and insisted on being connected to a medical clinic
where she was correctly told to begin rabies treatment within
48 hours. While receiving her fourth rabies vaccine, she noticed
that the substance in the syringe looked different than previous
injections. Again, a healthcare provider "misspoke," saying
that the drug was from a different manufacturer. When the
editor persisted, the nurse found that the drug was immune
globulin, not the vaccine. After receiving the final vaccine,
the editor realized that it had been given one week early.
Both the ED physician and the vaccine manufacturer "misspoke"
and suggested that she receive one additional injection. Yet,
when the editor called the CDC, she was told that no more
vaccines were necessary.
The editor noted that, for complex reasons, children often
talk authoritatively on topics about which they know little.
If they are not redirected to speak truthfully, they may become
adults who feel the need to "shoot from the hip" and provide
an answer regardless of what they know. Additionally, healthcare
providers are often pressured to give an answer instantly.
The editor believes that these conditions, more than an intentional
desire to deceive, cause "misspeaking." But intentional deception
sometimes occurs in healthcare, too. In a study with internal
medicine residents, subjects clearly indicated that it was
wrong to deceive their colleagues.2
But over 40% reported that they had witnessed residents intentionally
deceiving attending physicians and other residents. The study
found that the likelihood of deception was dependent on circumstances.
For example, twice as many residents (19%) admitted they would
make up a plausible answer for a forgotten laboratory value
if the attending physician was likely to ridicule and embarrass
them. Perhaps more important, a full 10% would still make
up the laboratory value even if they knew they would not be
reprimanded for not knowing it.
SAFE PRACTICE RECOMMENDATION: "Shooting from the hip"
sometimes hits the target, but seldom precisely. Serious errors
are possible when imprecision and misinformation are introduced
into patient care. Thus, it's important to evaluate your environment
to identify particular circumstances under which providers
are more likely to answer questions without confirmation.
To lessen the risk of off-the-cuff or less-than-truthful answers,
enhance awareness among educators, managers, and administrators
about the impact that their teaching or management style may
have on staff's behavior. They should serve as role models
and demonstrate that staff should not be afraid to admit that
they do not know the answer to all questions. Further, rather
than rush people for any answer, they should allow adequate
time for staff to provide the correct answer. Address the
issue during training programs using group discussions, simulations,
and role-playing. Finally, encourage patients to take an active
role in their healthcare and persistently ask questions if
they are not satisfied with the answers they receive.
1. Pearson L. Medical errors hit home. The Nurse Practitioner.
2. Green MJ, Farber NJ, Ubel PA, et al. Lying to each other:
When internal medicine residents use deception with their
colleagues. Arch of Intern Med. 2000;160 (15):2317-23.