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"Deny and defend" is as scary as Halloween. Don't be a Ghoul - disclose to your patients and families! Happy Halloween to our loyal readers.....we appreciate you and your help spreading the word about disclosure and apology.
THIS WEEK'S EDITION:
- Registration reminder for audio conference
- Tennessee ASHRM chapter invites Sorry Works! for a presentation
- Why angry patients and families are so angry - the Internet factor
- Question and Answer
- Observations from Texas
REMINDER: AUDIO CONFERENCE REGISTRATIONS DUE SOON! (CME/CEU CREDITS)
Registrations for the Sorry Works! nation-wide audio conference are due on Friday, November 7th. Don't miss out on this opportunity to hear an exciting panel of speakers including Dr. Geri Amori, Dr. Steve Kraman (first physician to implement a hospital-wide disclosure program), Joe Johnson (legal counsel, Triad Hospitals), Bruce Klores (med-mal plaintiff's attorney) and Doug Wojcieszak. The audio conference will count for CME and CEU credits - so gather the staff around the phone at 1pm EST on Tuesday, November 14. It's going to be a great conference - don't miss it!
To register, contact Melanie Gober at 517- 886-8226 (phone), (517) 327-4604 (fax), or e-mail: mgober@rmpsi.com. If you have a scheduling conflict and cannot listen to the live audio conference, a CD of the audio conference can be purchased. Again, contact Melanie for the details.
SORRY WORKS! TO SPEAK AT ANNUAL MEETING OF TENNESSEE ASHRM CHAPTER
Doug Wojcieszak, Sorry Works! Founder and Spokesperson, will be speaking at the Tennessee ASHRM Chapter on April 13, 2007. This is an exciting opportunity and the third visit to the Volunteer State for Sorry Works! over the last year.
If you are interested in a Sorry Works! speaker, please call 618-559-8168 or e-mail doug@sorryworks.net.
PART 2: WHY ANGRY PATIENTS AND FAMILIES ARE SO ANGRY....THE INTERNET FACTOR
In last week's newsletter we focused on how deny and defend breaks the bond of trust between healthcare professionals and patients/families, which causes the patient/family to become angry and more likely to pursue litigation.
While broken/violated trust is the principal factor that generates anger among patient/families, there is, however, an important mitigating factor that has become more prevalent over the last decade and a big reason med-mal has become a hotter issue: the Internet. That's right, the Internet!
Gone are the days where doctors are Gods and keep the facts and figures to themselves. Patients and families of old would accept that kind of relationship - but not today. Us modern folk approach our healthcare armed to the teeth with information. Type in your medical condition in a search engine and a plethora of websites will pop up with information, ideas, and advice. Patients and families are informed - and they want to be active participants in their care, as they should be. They have lots of questions and, yes, they saw that ad on TV last night for the new blue pill that will solve all of their problems.
To be fair, physicians and healthcare professionals who spent years perfecting their craft in school and residency programs must rightly feel a little put off by all of these "Internet physicians." However, there is an important dynamic here that physicians must understand and accept, especially as it relates to the med-mal arena.
When physicians clam up and run away after adverse events and the hospital or insurer refuses to share the charts, that's absolutely maddening for patients and families.
"You mean I can go on the Internet and find all these things about my disease, but I can't see my own charts? That's my chart! That's me! Why can't I see it?!! And why won't the doctor return my calls? It's like she just disappeared."
This point was driven home listening to Sorry Works! board member Dale Micalizzi talk about her son's case at the New Jersey Council of Teaching Hospitals last month. Dale lost her 11-year old son, Justin, to medical errors, but many years later the hospital still refuses to share the M&M and QA records and other parts of the charts with Dale and her family. Think about it. This is a child that Dale and her husband gave life to, changed countless diapers, threw birthday parties for, loved, and would do anything for but there is a hospital that refuses to share the records and details of the last moments of his life. How can that happen in America??
Medical administrators and defense lawyers may say, "Well, we can't share those records because of the lawsuit crisis....blah, blah, blah." This is the reason you have a lawsuit crisis. Wake up, medical community! Hiding information from a public well-versed in medicine is not a good idea. In fact it stinks! It's unethical and it's dumb! It's the reason you have liability problems.
Patients and families generally will not rest until they have answers, accountability, and fixes. Sorry Works! programs say you share the records whether you made a mistake or not. The records are your "friend." If you made a mistake, the records will prove to the patient, family, and their attorney that you are not covering up anything and your offer of upfront compensation is indeed fair and reasonable. If, however, you didn't make a mistake (it was just an adverse event), the records show you are speaking the truth - and not covering up!
Patients and families want information - no wonder medical websites are so popular and will continue to grow in popularity. People want to be involved in their care and the care of their loved ones, especially after something goes wrong. Don't turn these people out the door and hide information from them…bring them closer, share information, and make them your partners in correcting the problem. That's a med-mal fix everyone can feel good about! It's called Sorry Works!
QUESTION AND ANSWER:
Welcome to this week's Q&A with Dr. Geri Amori, RM&PSI Senior Director (www.rmpsi.com) and former ASHRM president and Doug Wojcieszak, Founder and Spokesperson of The Sorry Works! Coalition (www.sorryworks.net).
QUESTION: Who makes the disclosure and apology under Sorry Works? The doctor or nurse? Hospital or insurance administration? Some of our doctors are wonderful communicators but others are horrible. What do we do?
Geri: This is always a sticky question.....Doctors will ask, "Why should I be involved if it's not my error?"; administrators and risk managers will say, "I don't want that doctor involved. He (she) is likely to confess things that aren't true or alienate the patient."
What we have found is that patients are treated in the hospital, but often consider themselves the patient of the doctor, not the organization. In addition, medical errors elicit medical questions. Although you don't want the physician talking to the patient and saying inappropriate, inflammatory, or inaccurate things, you also don't want the patient to feel like the physician is hiding or covering up information. We usually recommend a system in which physicians participate in the disclosure, but may not necessarily do the disclosing. A healthy system supports disclosure by ensuring that physicians feel safe discussing and role-playing the conversation with risk management, or another identified person. The goal of the role play is to ensure the physician has the correct information and is prepared for whatever emotional reactions he/she may receive. In addition, supportive systems provide for someone to accompany the physician, either as the spokesperson, or to help read the non-verbal reactions of the patient/family to ensure that empathic and effective communication occurs.
So, who should disclose? Whoever has excellent communication skills, is empathic and caring, and who has the right information. Generally speaking, unless the physician is too upset to participate, it would be good for them to be there to answer the medical questions asked by their patient. If it is too risky for the physician to participate, then someone needs to be there to answer medical questions. Finally, it depends upon which disclosure discussion is being held. At the initial disclosure of an anticipated event, it is probably premature for insurance administration to be there. If, however, this is the second or third meeting where we know the nature and result of an error, then individuals who are authorized to remunerate could be participants. I think it would be very rare for those individuals to make the actual disclosure under any circumstances.
Doug: I am going to parrot Geri's opening remark from last week’s Q&A: "It depends." You need to know your medical providers and hospital/insurance staff, and you also need to know the feelings and wishes of the patient or family. For example, you may have the most humble, warm, and caring doctor on the planet, but the patient/family might be so angry at that physician that you probably need to exclude him/her from the meeting - for now. Let the disclosure process work on the patient and family and see if there is an appropriate time down the road for the patient/family and physician to meet. However, on the other hand, you may have an arrogant doctor who is a horrible communicator, so you don't want that person anywhere near the disclosure process. It just depends.....you need to know your staff as well as the patient/family. When implementing a disclosure program, you will have a core group of people from hospital administration, risk management, legal, and the medical staff trained on the program and this team will make the determination on a case by case basis of who is best to break the news to the patient/family.
OBSERVATIONS FROM TEXAS
Last week Sorry Works! traveled to the Lone Star State to speak at a retreat organized by the Baylor University Medical Center. We received a fantastic reception and learned that Baylor has a disclosure program in place. This is exciting news.
We also had two additional private meetings that went very well and we hope to make public announcements about them in the not-to-distant future.
Some observations on Texas.....as we all know Texas is the land of Amendment 12, which made tort reform style caps part of the state constitution. We've heard the stories about insurance premiums going down and more doctors and insurers coming to the state. And we, at Sorry Works!, have received many calls from Texas patients and families and the conversation usually goes something like this: "Something bad happened to my loved one, the hospital or doctors won’t talk to me, and after Amendment 12 I can’t find a lawyer to take my case."
Question to the Texas medical community: Is this a good thing? Is this something to be proud of? A patient has an adverse event, you and your system literally throw the patient/family on the street, and then they can't get answers from anybody - even a lawyer? Is that a reason to celebrate? Time to "High Five" each other? Is this why you went to medical school?
But we also get other calls from Texas....despite all the "successes" of Amendment 12 we have received many calls from hospitals, doctors, and insurers in Texas over the last year. We've had two major speaking engagements so far in the state, another one booked in December, and many ongoing conversations with folks in private. What's going on here?? If Amendment 12 was supposed to solve all the problems, why the phone calls from hospitals, doctors, and insurers?
Perhaps our messages of self-determination and truly solving the problem are finally sinking in with folks in Texas.
Political solutions - like caps - are arbitrary and can be taken away at any time. Look at Wisconsin.....a state with caps in place for years, a supposedly great place for docs, only to have a new and different Supreme Court throw out the caps. Same thing could happen in Texas after President Bush, Tom DeLay, and the Republican Party are finished imploding. A new legislature and a new court could weaken or even eliminate Amendment 12. Furthermore, regardless of the legislature, the Texas trial bar will learn over time how to get around Amendment 12.
This is the problem you run into when you treat med-mal as a legal problem to be solved by politicians.....when in fact med-mal is truly a customer service problem to be solved by healthcare professionals.
Excellent customer can be instituted at any time, it never can be taken away by a politician or judge, and it truly addresses the root causes of the problem. The excellent customer service instilled by Sorry Works! removes the anger experienced by patients and families after adverse events and in most cases the need to file a lawsuit. That's a med-mal fix that's truly good for patient, families, and healthcare professionals.
We'll keep you posted on our efforts in Texas....and please help us with your friends and colleagues in the Lone Star State. Please forward this newsletter to the Texas Medical Association and others. Thank you!
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