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August 27th, 2007 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
- FINAL REMINDER: Sign up for next week's audio conference with Lee Taft, ethicist and former med-mal trial lawyer
- Chicago Tribune Editorial on Disclosure
- Question & Answer
FINAL REMINDER: SIGN UP FOR NEXT WEEK'S AUDIO CONFERENCE WITH LEE TAFT, ETHICIST AND FORMER MED-MAL TRIAL LAWYER
We hope you will join us next week for an advanced disclosure conference with Lee Taft, ethicist and former med-mal plaintiff's attorney. The title of the audio conference is "Disclosure: Is it worth the risk?" In short, this audio conference will examine and evaluate the risks of disclosure - especially those that are coupled with authentic apology - from the perspective of a person who used to represent those injured by medical error and who now designs and implements disclosure programs for hospitals.
For twenty years Lee Taft worked as a dually board certified trial lawyer. He came to realize that even when the injured party recovered a favorable verdict or settlement, justice was often incomplete. This point was driven home after Taft successfully prosecuted a case on behalf of a young woman with small children. Her husband died as a result of preventable, medical errors. None of the physicians ever accepted responsibility for the errors that led to her husband's death. If they had, she said she could heal. Yet, accepting responsibility carries significant institutional and personal risk. Taft's work bridges the gap between patients' desires and providers' fears.
Taft now has a national consulting practice in which he implements disclosure programs - writing disclosure policies, educating from the board room to the floor nurse, and working with risk managers and defense lawyers in the wake of error by embedding disclosure into litigation strategy. While he is a proponent of apology in some disclosure contexts, you will quickly learn his approach is not pollyannish.
In this program Taft will identify risks disclosure creates and show you how to evaluate and avoid those risks. This program will bring disclosure theory into practice, a "can't miss" event for all those struggling to make disclosure a reality in their institutions.
The conference will be hosted by Dr. Geri Amori of RM&PSI.
The cost for the audio conference is $199. The conference will count for CME/CEU credits. To register today, please contact Melanie Gober of RM&PSI at 517-886-8226 or mgober@rmpsi.com. For additional information including a brochure on the conference please visit this link:
http://www.sorryworks.net/pdf/Web_Brochure_CME.pdf
CHICAGO TRIBUNE EDITORIAL ON DISCLOSURE
Last week in a special Sorry Works! newsletter we shared the good news about the Chicago Tribune front page story on apology and disclosure and the successful disclosure program at the University of Illinois Medical Center.
This week we are sharing a follow-up editorial from the Tribune on disclosure and apology, which also discusses the new Medicare payment rules for errors. Interesting note: The Tribune editorial board still holds onto some old style med-mal thinking in opining that apology and disclosure probably won't derail a lawsuit with an egregious error, but the experience from the field has been exactly the opposite. A real apology with a commitment to fix problems - including offering upfront compensation - stops most lawsuits, even with horrible medical mistakes. We know our readers will find this piece interesting. Please share with friends and colleagues.
Chicago Tribune
August 23, 2007
Editorial - Give it to us straight, doc
When a surgeon screws up and leaves a sponge in a patient -- or worse, operates on the wrong part of the body -- the rest of us wonder, in amazement and anger, how such a mistake could ever happen. Ditto the less sensational but equally outrageous stories of hospital-borne infections that sicken or kill thousands of patients, often because medical personnel don't do something as simple as wash their hands.
In many cases the outrage is compounded by the perverse economics of medicine: Rather than being docked for the error, doctors and hospitals that foul up are paid more, for additional surgeries and extended hospital stays.
But that, thankfully, is changing. Medicare announced recently that it will stop paying the costs of treating certain kinds of preventable errors, including certain hospital-acquired infections, objects left in surgical patients, bed sores, and transfusions with incompatible blood. With its enormous clout, Medicare's move is likely to accelerate efforts already under way by private insurers and major companies to persuade hospitals to waive charges for certain so-called "never events" -- mistakes that should never happen. That's hugely important. Medical errors, preventable and not, add billions to the nation's medical bill -- and take a horrendous toll in patient suffering and deaths. Many medical errors can be traced to badly designed hospital systems or sloppy work. As Dr. Donald Berwick, head of the non-profit Institute for Healthcare Improvement, has said: "This isn't a matter of doctors and nurses trying harder not to harm people. Safety isn't automatic. It has to be designed into the system."
Most doctors are still too afraid of malpractice lawsuits or too worried about losing standing among colleagues to acknowledge an error, preventable or not, and take responsibility for it, including a direct apology to a patient or a family.
But as the Tribune's Judith Graham reported recently, Chicago is figuring prominently in the emerging "fess up" movement. The University of Illinois Medical Center at Chicago runs a comprehensive error disclosure program that is drawing national attention. And the university's medical school trains doctors about how to deal with mistakes. That's important because disclosure of major errors can help improve care for everyone.
Many doctors remain skeptical, however, because most people tend to take apologies as admissions of guilt. And even the most heartfelt apology isn't likely to derail a lawsuit in an egregious case. But a doctor sitting down with a patient and her family and talking about what went wrong and why is vital. The patient or the patient's family may be able to help doctors or hospitals understand where communications broke down or how errors occurred. They may even suggest ways to fix problems. "The patient is not our enemy," says Dr. Tim McDonald, UIC's associate chief medical officer for patient safety. "Too often what happens is...we go into 'deny mode' and then stop communicating with them."
The point of Medicare's action and the nascent apology movement isn't -- shouldn't be -- to persecute doctors or hospitals for disappointing outcomes. Surgeries and treatments can fail, not because of the doctor's proficiency, but because of other factors, including a patient's overall health and age. There's no guarantee of success with medicine, no matter how skilled the doctor, or how superb the hospital. Doctors can't always anticipate complications.
Simply canceling part of a bill or issuing an apology won't be a panacea. But a system that rewards errors and encourages secrecy about mistakes is bound to perpetuate both. That's not healthy for patients or doctors.
QUESTION & ANSWER
Time for another installment of "Question & Answer" with Dr. Geri Amori of the Risk Management & Patient Safety Institute and Doug Wojcieszak of The Sorry Works! Coalition.
Question: What do you do if the family refuses to believe you?
Geri: You recognize it, acknowledge it and accept it. The purpose of telling the truth isn't to convince someone you are right. It is to be transparent and to give the other person the information they need to do whatever they need to do.
When in the middle of a conversation you sense that you are not being believed, it is quite appropriate to state, "This must be difficult to believe. I would have a tough time myself. I hope you will give me the benefit of the doubt, and I will understand if you feel you can't." By acknowledging that they may not believe you and that it acceptable not to, you have opened the door for them to respond openly.
There may be times when you think you have been understood. You learn later that was not true. In your next conversation I would ask simply, "What would you need to know that we are being open with you?" They may respond that there is nothing you can do. In contrast, they may want to see a specific piece of information.
While it is essential that we in healthcare are open, honest and trustworthy, we do not have the right to expect any specific type of reaction from patients. Their lack of trust or disbelief comes from their experiences, their belief systems, and their pain. Our job is not to make their pain worse by hiding what we know.
Doug: I think this question is a perfect example of why it is important to have communication and a working relationship with your local trial bar. While a patient or family may not believe you because of their emotions or other issues, a trial lawyer - who may be contacted by the family - is going to be a little more objective if they are contemplating sinking $50,000 to $100,000 in a case. That objectivity may be enhanced if they (the trial lawyers) know you are an open and honest facility that doesn't play games with patients and families. Instead of filing papers with the court, the trial lawyer may call you and ask what the case is about and what your investigation shows. This is your chance to prove your innocence to a person who is experienced in medical malpractice. But you only get this chance if the lines of communication are open.
This approach may seem "unrealistic" to risk managers, claims professionals, and defense counsel hardened by years of battle with their local trial bar. But has battling with trial laywers been a winning approach? Sure, you've probably won lots of cases, but at what cost? After an adverse event everyone's interest are the same...what's the truth? And the good news is in the immediate aftermath of a potential error litle or no money has been invested by either side and hunches haven't hardened into beliefs. Instead of bashing the trial bar reach out and work with these people and you might be surprised.
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