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THIS WEEK'S EDITION:
- Last chance to register for Sorry Works! audio conference
- Whole new world
- On the road again/new speaking engagement
- Question and Answer
- Little more on tone and tenor of these newsletters
Last chance to register for Sorry Works! audio conference
This is the last day to register for the first-ever Sorry Works! audio conference. The conference is scheduled for tomorrow, Tuesday, November 14th at 1pm EST. Remember, the conference counts for CME and CEU credits.
To register, contact Melanie Gober at 517-886-8226 (phone), (517) 327-4604 (fax), or e-mail: mgober@rmpsi.com. You can register quickly and easily today with a credit card and phone call to Melanie.
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.
Whole New World
Last Wednesday marked the beginning of a whole new world in the med- mal crisis. The U.S. Congress went Democrat, and you can bet the ranch Speaker Pelosi and Senate President Reid won't be calling bills for tort reform or health courts anytime soon - if ever. The Republicans are on the run at the state level too. Politics is a finicky business. One day you're up, the next day you're down, and who knows what will happen tomorrow?
Some might say, "But look at all good with tort reform coming out of Texas, shouldn't we simply re-double our efforts? After all, the next election is only two years away?!" We'll answer this question with a question: "What about Wisconsin?" They had caps in place for years and it was the doctors' paradise, but a new supreme court and governor took the caps away. Also look at Louisana - the Democrat-controlled legislature is set to raise the caps.
Political solutions are never full-proof or perfect. Advances and gains can be washed away quickly with the changing tides. Control is difficult to maintain - but better control over liability is exactly what doctors, hospitals, and insurers want. To get better control maybe it's time to remove med-mal from the political arena and treat the issue as the customer service problem it is. The vast majority of patients and families sue because of anger, not greed. The peer-reviewed medical literature has countless studies that back up this assertion. So, if you are dealing with an anger problem - not a greed problem - it reasons that an excellent customer service program can solve the vast majority of your liability problems. Furthermore, an excellent customer service program will give you better control of your liabilty problems by 1) maintaining better control of relationship with patients and families (instead of destroying relationships with deny & defend); and 2) by removing the issue from the uncertainties of the political arena.
Sorry Works! provides the framework and guidance to solve your liabilty problems with a customer-service centered approach to adverse events and medical errors. We are here to help, and we hope you, our readers, help us by forwarding this e-newsletter to the leadership of different national and state medical groups. After last Tuesday elections these groups are undoubtedly looking for a new way to solve their liability problems, and you can help by sharing the Sorry Works! message. Thanks!
Tales from the road/on the road again/new speaking engagement
Great road trip last week speaking to the Execummit Insurance Conference and Physicians' Reciprocal Insurers (both in New York City) and the Colorado Patient Safety Coalition in Denver, CO. Great response from all three engagements, and we heard some wonderful speakers and learned some new information .
Nationally-known med-mal defense attorney Jim Saxton gave a great speech at the ExecuSummit Insurance Meeting. Jim is a very powerful speaker with an important message. Not only is he focused on disclosure but also improving quality and safety in medicine. Among many interesting points Jim made, consider the following: Plaintiff's attorneys are actually turning down a lot of cases, even cases with serious injuries or deaths. According to Jim, the plaintiff's attorneys not only want serious injuries or death with medical errors, but they also want to see a cover-up, phone calls not returned, lack of communication, deny & defend, etc. Jim said deny & defend creates a "Plus Factor" that truly angers juries and can lead to large, profitable verdicts. Simply put, cover-ups are no longer acceptable after adverse medical events; communication and disclosure are a must.
At the Physician's Reciprocal Insurers meeting, Dr. John Banja of Emory University and Sorry Works! board member did a wonderful job. John has a unique and engaging delivery style that incorporates a lot of humor to drive home important points. One point that really struck home was a role play John did with a member of the audience whereby John imitated a doctor who examined a patient complaining of back pain, ran several tests, and then refused to share the diagnosis with the patient. Sounds absurd, right?! Yes, the audience had a great chuckle, but then John made the point that medicine does exactly the same thing with deny & defend after adverse medical events. Point made.
Sorry Works! received a great reception at the Colorado Patient Coalition meeting in Denver on Friday. Over 200 healthcare and insurance professionals as well as consumers made for a wonderful audience. Afterwards, Sorry Works! learned that the University of Colorado Hospital has had a disclosure program in place for years that has produced significant savings. This is great news and we are happy to report this information. We know there are many more successful disclosure and apology programs out there - we need to hear about them. The sooner more programs share their information, the sooner Sorry Works! will become mainstream and the doubters and obstructionists will melt away.
Dr. Banja and Doug Wojcieszak will be speaking to Advocate-Lutheran General Hospital in Chicago this week, and Doug received an invitation to speak at the Reading Hospital and Medical Center in West Reading, PA in late April 2007.
If you are interested in a Sorry Works! speaker, please send an e- mail to doug@sorryworks.net or call 618-559-8168. Thank you!
Question & Answer
Welcome to this week's Q&A with Dr. Geri Amori, RM&PSI Senior Director (www.rmpsi.com) and experienced risk manager, educator, and counselor and Doug Wojcieszak, Founder and Spokesperson of The Sorry Works! Coalition (www.sorryworks.net).
Q: I had a patient who developed a post surgical infection from a retained abdominal sponge. She was a pleasant woman and because she was large, she knew there was a high likelihood of surgical complications. I disclosed the source of the infection as soon as we knew it and apologized. We took her back to surgery, removed the sponge and she healed nicely. Her length of stay was increased by about 4 days. She took a while to heal and she had many co- morbidities. She was pleasant, understanding, and seemed to be satisfied with our apology and care. Today I received word that her daughter, a lawyer, has encouraged her to sue us alleging that the additional time spent in the hospital caused her to lose work and to be permanently distrustful of the medical system. What went wrong?
A: Geri: Based upon the facts you've provided, it's difficult to see what might have gone wrong during your conversation. In fact, it sounds as though you did all the right things.
There are a few things to remember when we apologize or disclose that seem counter-intuitive but are real:
1) Apology and disclosure are not for the purpose of avoiding litigation. People sue for many reasons. The goal of disclosure and apology is to give patients and families the information they need to make decisions…including, perhaps the decision to pursue litigation. Although it sounds like we're giving them ammunition for a lawsuit, the truth is that many patients are satisfied with the disclosure and apology so long as we reassure them that we will fix the systems problems and we make things right for them. Perhaps your patient didn't anticipate the financial consequences of the lost work. Perhaps her daughter felt guilty in some way, and in her frustration convinced Mom to sue. Perhaps the patient had an underlying depression that didn't emerge until after the event. Many emotional and financial factors color the desire to sue. Although the primary factor is anger or frustration, we can't always predict what will trigger these. What is known is that the organizations and providers who have been honest, open, and straightforward will be viewed in a better light by the courts and juries than those who hide the truth.
2) It is natural to assume that because the conversation goes well, the problem is solved. This may not be so. Disclosure and apology are not a single event, but a multi-layered process. The patient who is "pleasant" may be in denial, may not fully appreciate the event, or may not want to upset the providers. It may not be until the information is absorbed and other family members become involved that the impact is felt. It is important that we approach the patient/family several times to ensure that questions are answered and that the information is understood. It is generally unwise to leave it up to the patient/family to take responsibility for approaching us for the second conversation.
Bottom line: You may have done everything right in your initial disclosure conversation. You just weren't done yet. This patient exemplifies the need for multiple conversations. I would suggest that those patients who are the most "pleasant," "agreeable," and least upset are those with whom repeat conversations might be most critical. Those who express anger need the repeat conversation in order to ensure the information is understood. Those who appear most pleasant, need the repeat conversation in order to ensure the information was absorbed.
A: Doug: Geri hits it on the head again. Communication is not a one-time deal, especially after adverse medical events. Often times patients and families are emotional basket-cases for hours, day, even weeks and months after such events. You as the healthcare provider have to continue reaching out and communicating, making sure they understand. When communicating with patients and families, a good tool is to ask them to speak back to you what you said so you can make sure they understood. Remember, you're the expert in medicine and the patient/family are the lay people, so you have to make sure your communication efforts connected.
In this particular case, you should have also asked the patient if she had anyone in the family you could communicate with, like her daughter. As Geri said, family members can push people to litigation after the facts have sunk in, and your experience might have been very different had you also reached out to the lawyer-daughter as well as other family members.
Some healthcare professionals may say they are too busy to make such an effort, but it sure beats the alternative of getting sued! Do you have time for depositions, discovery, and maybe a trial?
Another point to consider: Your apology may have not been complete. In your question you said the woman had to spend four (4) extra days in the hospital and took a long time to heal. Did you offer fair, upfront compensation such as waiving the bills, providing compensation for lost time from work or family, offering to pay for bills, for example, to have her pets fed or her lawn cut, etc, etc?? Apology and disclosure takes anger away from patients and families, and when anger is removed you can get creative and meaningful discussions around the issue of compensation for the damage done - but you must address compensation or your apology could be viewed as meaningless and hollow.
If you have question, please e-mail doug@sorryworks.net or gamori@rmpsi.com. Your indentity will remain confidential - thank you!
Little more on tone and tenor of these newsletters
Last week we spent some time explaining the tone and tenor of these newsletters and why some sections have a bite and punch to them. We received good response to this explanation, but we also continued to receive some negative vibes and feedback.
We've made a lot progress over the last two years...many healthcare and insurance organizations are seriously studying Sorry Works!/disclosure and several are on the road to implementing the program. That's great and we applaud these folks, and these biting/sarcastic sections are not aimed at these folks in any way. Please understand this.
Unfortunately, there are several tough nuts out there who will not change. Deny and defend is their way of doing business, come hell or high water.
This is a situation not unlike episodes we all deal with in the work place every day. We all have those difficult colleagues, and some times you can get them to cooperate by gently encouraging them and helping them find their way in the organization. However, nice doesn't always work. Some times you have to say, "Look, buddy, you're either going to get this report to me or I'll be in your supervisor's office tomorrow morning!" We've all done this sort of thing, and some times people have rightly done it to us!
Let's be clear: Deny and defend is unethical, immoral, and just plain wrong. It has no place in medicine or any business dealings or human relationships. Some folks have figured this out, while others are slow to the party. What is aggravating this situation is that for the first time in medical history an outside group (our group, Sorry Works!) has risen up and said no more deny and defend - and we can show you a better way with honesty and disclosure. That represents a major change in the "doctor/patient relationship." For too long that relationship has been a one-way street, and some in healthcare don't appreciate us speaking up.
But we will continue to speak, talk, and educate. We will continue on with our friends who understand the value of honesty and disclosure, and we'll eventually drag the rest along, even if they are kicking and screaming.
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