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On the prospects for a blame-free medical culture

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  • Collins, Molly E.
  • Block, Susan D.
  • Arnold, Robert M.
  • Christakis, Nicholas A.

Abstract

Official policy-making bodies and experts in medical error have called for a shift in perspective to a blame-free culture within medicine, predicated on the basis that errors are largely attributable to systems rather than individuals. However, little is known about how the lived experience of blame in medical care relates to prospects for such a shift. In this essay we explore the benefits and costs of blame in medical culture. Our observations are informed by our clinical experience and supported by interview data from a study in which 163 American physicians were interviewed about caring for a total of 66 dying patients in two institutions. We observe three ways in which blame is invoked: (1) self-blame, (2) blame of impersonal forces or the "system," and (3) blame of others. Physicians articulate several important functions of blame: as a stimulus for learning and improvement; as a way to empathically allow physicians to forgive mistakes when others accept responsibility using self-blame; and as a way to achieve control over clinical outcomes. We argue that, since error is viewed as a personal failing and tends to evoke substantial self-blame, physicians do not tend to think of errors in a systems context. Given that physicians' ideology of self-blame is ingrained, accompanied by benefits, and limits a systems perspective on error, it may subvert attempts to establish a blame-free culture.

Suggested Citation

  • Collins, Molly E. & Block, Susan D. & Arnold, Robert M. & Christakis, Nicholas A., 2009. "On the prospects for a blame-free medical culture," Social Science & Medicine, Elsevier, vol. 69(9), pages 1287-1290, November.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:9:p:1287-1290
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    References listed on IDEAS

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    1. DelVecchio Good, Mary-Jo & Gadmer, Nina M. & Ruopp, Patricia & Lakoma, Matthew & Sullivan, Amy M. & Redinbaugh, Ellen & Arnold, Robert M. & Block, Susan D., 2004. "Narrative nuances on good and bad deaths: internists' tales from high-technology work places," Social Science & Medicine, Elsevier, vol. 58(5), pages 939-953, March.
    2. Mizrahi, Terry, 1984. "Managing medical mistakes: Ideology, insularity and accountability among internists-in-training," Social Science & Medicine, Elsevier, vol. 19(2), pages 135-146, January.
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    1. Schrøder, Katja & la Cour, Karen & Jørgensen, Jan Stener & Lamont, Ronald F. & Hvidt, Niels Christian, 2017. "Guilt without fault: A qualitative study into the ethics of forgiveness after traumatic childbirth," Social Science & Medicine, Elsevier, vol. 176(C), pages 14-20.
    2. Doherty, Carole & Stavropoulou, Charitini, 2012. "Patients' willingness and ability to participate actively in the reduction of clinical errors: A systematic literature review," Social Science & Medicine, Elsevier, vol. 75(2), pages 257-263.

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