It has been said that if you scratch the surface of a person's work you will find a personal concern or experience, a passion - for knowledge, justice, solution to a burning problem, or other - that prompts or helps to drive her or his work, even when that work is highly rational, scientific, and impersonal on the face of it. The reach of that rule of thumb is not clear, but there is some truth in it for us, the editors of this volume.
Antonella Surbone, a medical oncologist who trained and worked in Italy and in the USA, gathered clinical experience on the importance of patient safety and communication with cancer patients. From my almost 20 years of oncology practice in New York at Memorial Sloan Kettering Cancer Center first and Bellevue Hospital, I came to understand the urgent need to apply the new culture of prevention and disclosure of medical errors indicated by the 1995 IOM Report "To Err is Human" to the field of oncology. Complex and multidisciplinary treatments are required - at times of an experimental nature - in oncology, and almost all cancer patients interact with different specialists during the course of their illness, making the art of oncology prone to the occurrence of medical errors. In light of my personal and scholarly interest in the ethical and social implications of medical oncology and in cross-cultural differences in its practice worldwide, I focused my attention and research on the impact of medical errors on the patient-doctor relationship and the reciprocal trust that sustains it. Observing and experiencing on a daily basis the strong bonds that can develop between cancer patients and oncologists and nurses, and witnessing and studying the contextual and cultural dimensions of clinical cancer care, I also explored ethical and communication aspects of medical errors in oncology.
During roughly the same period of time, the second editor, Michael Rowe, a medical sociologist, was studying the encounters, negotiations, and transactions of persons who were homeless with mental illnesses and outreach workers, along with the social, institutional, and professional contexts that shaped those encounters. During this time my son underwent organ transplant surgery and died from complications of the surgery after a three-month hospitalization. I wrote about Jesse's experience of medical error and other aspects of illness and patient-doctor relationships from both personal and professional perspectives in a book and in medical, narrative medicine, and bioethics. As examples, I wrote that closure after the death of a loved one is a myth, and that breaking the barrier of silence that still surrounds most medical errors could ease the suffering and anguish of patients and families and of health professionals.
Antonella, as Ethics Editor of Critical Reviews in Oncology/Hematology, became aware of Michael's work and asked him to write an article on the theme of doctor's responses to medical errors, with an emphasis on doctors' and strong emotions of participation in a medical error and doctors' anguish over harm done to patients, how to talk to patients about errors, and how they lived with them personally and professionally. She wrote a commentary that was published with the article, noting and expanding upon its themes and suggesting topics for future exploration. Our shared interest in medical error, patient-doctor relationships and communication, and their social and cultural contexts subsequently led us to conduct two educational sessions at the American Society of Clinical Oncology Annual Meetings of 2005 and 2012, to joint writing and research, and to this volume.
Some readers, especially those acquainted with the vast research, policy, and scholarly literature on medical error and patient safety, will notice that a few important areas such as litigation and others are not the core topics of our book. While each of these domains is addressed in part in different chapters, often through illustrations, our backgrounds and particular medical and humanistic concerns are reflected in the main themes and underpinnings of this book, the first volume to our knowledge on the topic of medical errors and error reduction in clinical oncology.
The nature of oncology care renders the discipline and practice of oncology both uniquely vulnerable to the difficulties associated with identifying, understanding, disclosing, and managing medical error and its aftermath, and uniquely situated to provide medical leadership regarding medical error within and beyond its disciplinary boundaries to medicine. We hope that our book will start a conversation both on confronting medical error in oncology and in taking up the unique contribution that the field of oncology and oncology professionals can make to addressing medical error and its consequences, focusing on restoring trust among all partners involved.