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THIS WEEK'S EDITION:
- Focus on Dr. John Banaja
- On the road again...
- Tone down the rhetoric between doctors and lawyers
FOCUS ON DR. JOHN BANJA
This week we put Dr. John Banja, author of "Medical Errors and Medical Narcissism" in the focus spotlight. Dr. John Banja will be one of two featured speakers for our May 9th audio conference. We hope you enjoy this printed interview below, and to hear Dr. Banja live be sure to register for our audio conference by calling 517-886-8226 and asking for Melanie or by pasting this link into your browser: http://www.sorryworks.net/conference1.phtml.
SW!: Medical errors and medical narcissism are not topics that most kids dream of working on one day for a living – what led you to this interesting and different line of work?
Dr. Banja: When I began teaching medical ethics nearly 30 years ago, I taught the usual stuff on informed consent, privacy, confidentiality, access to health care, end of life, etc. When I started sitting on ethics committees and observing health professionals working in the trenches, however, I couldn't help but notice that many of the dilemmas they encountered came with a very heavy emotional toll. I got increasingly interested in the "feeling" or affective dimension of delivering health care and the psychological distress that often accompanies ethical dilemmas. I especially got interested in how health professionals handle (or mishandle) emotionally difficult conversations, which virtually always seemed a part of real-live ethical situations.
What I saw was that these situations are psychologically difficult because they threaten the self-image that health professionals want to preserve about themselves-namely, that health professionals are competent, informed, in control, confident, and capable. All professionals, no matter what their discipline, want to feel this way about themselves. This is the "narcissist" in us all, which, incidentally, is fine so long as it doesn't get out of control. People should feel good about themselves and have a healthy love of themselves and others. However, there is nothing like the occurrence of a serious, harm-causing medical error to shatter that image. Over the years, I worked on how these ideas interrelate: how the feeling world of the health professional is intimately connected with a self-image of adequacy and competence; how the emotionally turbulent world that health professionals live and work in is constantly threatening that self-image; how health professionals defend against situations that threaten that image; how managing serious medical errors offers an extraordinary glimpse into the moral and psychological formations of health professionals and their institutions; and how relational techniques bearing on empathy are key if we are to artfully manage the affective dimensions of ethical situations and the way poorly controlled feelings can compromise our relationships with patients.
SW!: You put your thoughts and ideas into a very well-written and comprehensive book entitled, "Medical Errors and Medical Narcissism." What are the three (3) main take-away points you hope readers get from your book?
Dr. Banja: 1) That we haven't understood the problem of managing medical error conversations for what it really is: a "customer relations" issue, as Sorry Works! has suggested. The patient and family are the ones to whom you owe an ethical obligation and who can sue you. The artful error disclosure conversation will therefore impress them with the compassion and honesty of the discloser and his or her institution.
2) That if you are truly "patient-centered," you will disclose a harm-causing error in a way that the listener can understand - such that if the listener comes away from the conversation not feeling respected and not understanding that an error occurred, the conversation was a moral failure. (This is especially applicable to hospitals that explicitly have an "error disclosure policy." If, after an error disclosure conversation, the patient or family still don't understand that an error occurred, that disclosure policy is not working.)
3) That we do an inadequate job in many of our medical/nursing/therapy schools in preparing future health professionals to manage emotionally difficult conversations. The requisite skills are difficult but learnable. You don't have to be a "touchy-feely" type of person to gain some mastery of them. The professoriate simply must do a better job of teaching them. The professoriate must stop believing that because a person is intelligent enough to be accepted into a medical or nursing school, he or she also has the requisite emotional intelligence to handle all the emotional abuse that will inevitably occur in his or her career.
SW!: Good authors always get speaking invitations - what types of organizations are inviting you to speak to these days? Who are you most frequently talking to?
Dr. John Banja: Mostly hospital groups, especially composed of ethics/QI/patient safety representatives. I'm also delighted to be doing a number of conferences throughout the United States for AIG insurance, who is recommending a model of transparency and disclosure for its insured hospitals and health care facilities. Sometimes, though, I feel as though I'm preaching to the choir because I very much think that these audiences understand the importance of empathy. I continue to believe that it's the physician staff who really struggle with disclosure and often do a poor job of it. They are terrified about lawsuits (which is understandable, of course) but, unfortunately, many of them are accustomed to telling only a version of "the facts" that they want the listener to have, not the version the patient would want to hear or that would most accommodate a "patient-centered" approach.
SW!: Without giving anything away, give us a sneak peak into your presentation for our May 9th audio conference.
Dr. John Banja: We're going to be talking about health professionals apologizing and asking for forgiveness in the event of harm-causing medical error. For so many of them, that will be an immense challenge to their professional narcissism. Apologizing and asking for forgiveness requires humbling oneself. It means setting aside that insistence on always appearing adequate, competent, and in control. It means admitting to human frailty and imperfection. It also means letting go of the 20th century approach to error, which was largely that of concealment or evasion. And that's why it's so hard for many professionals, especially if their narcissism is unreasonable, and they continue to be wedded to the idea of perfection.
Our thanks to Dr. Banja for a great interview, and we hope you'll be listening in live to Dr. Banja on May 9th at 1pm EST. Again, to register for the conference call 517-886-8226 and ask for Melanie or paste this link into your browser for registration information: http://www.sorryworks.net/conference1.phtml.
ON THE ROAD AGAIN
Sorry Works! spokesperson Doug Wojcieszak has been spending a lot of time in airports and hotels lately, and will do more of the same over the next two weeks. Wojcieszak was the keynote speaker at the Tennessee Risk Managers annual conference two weeks ago, then flew to Charleston, South Carolina to speak to the JUA/Marsh board of directors, and then spoke to three different Adventist Hospitals in Chicago last week. This week it's the North Carolina Association for Healthcare Quality and then off to Reading Hospital in Reading, PA. Next week it's the CHS Hospitals Risk Managers Meeting and then off to California to speak to the Southern California Assocation of Healthcare Risk Managers. Busy, busy.
To book a Sorry Works! presentation, contact doug@sorryworks.net or call 618-559-8168. Thank you!
TONE DOWN THE RHETORIC BETWEEN DOCTORS AND LAWYERS
The med-mal crisis has turned many doctors and lawyers into bitter enemies. Insults have been traded freely - and too often - between the two professions. Docs call lawyers "shark in suits," "bottom feeders," "greedy ambulance chasers," and many other "terms" not fit for print. Lawyers call docs "sloppy," "egotistical," "arrogant," "God-like," and also many other terms not fit to print. There is such an intense hatred and distrust between lawyers and doctors. It's got to stop. The hatred puts patients and families in the middle of protacted battles where answers and justice are a long-time coming, if ever. The hatred and distruct leads to the filing of countless non- meritorious - or frivolous - lawsuits, and patients and families suffer as do docs and lawyers. Everyone loses time, money, and sleep, including the lawyers!
Perhaps the greatest value of disclosure and apology programs is the chance to rebuild bridges and re-open communication between physicians and lawyers. To get the two professions to work together to find the truth about what happened during an adverse event. Of course, you can almost hear some physician screaming, "But, you don't understand, these greedy trial lawyers just want a buck...they don't give a damm about the truth!" Sure, just like there are some horrible physicians who shouldn't be caring for patients, but they continue to do so because they hire good attorneys to protect their licenses from the medical boards. If we can remove these extremes (greedy lawyers, bad docs) from the equation, we can then agree that the majority of physicians and lawyers simply try to do their job every day...and their job after an adverse event is to find the truth for patients and families. Disclosure programs allow for physicians and lawyers to seek the truth in a relatively quick fashion and then provide any amends to the patient/family, if necessary.
In fact, disclosure programs work best when trial lawyers are engaged in the program and encouraged to contact the hospital or insurer with potential claims and cases so both sides can share information and learn what happened quickly, without the name calling.
Time to stop being angry at one another...give the name calling a rest...and time for physicians and attorneys to treat each other like the professionals they are and seek the truth for those they are pledged to serve.
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