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December 8, 2008 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
THIS WEEK'S EDITION:
December 8 NEWSLETTER
Doug Wojcieszak, Founder & Spokesperson
Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net
IN THIS EDITION:
- SORRY WORKS! EDITORIAL: Saying Too Much Too Soon and Off-Handed Comments
- Fifteen (15) Sorry Works! Presentations Already Booked January through April
- Article & Commentary: Malpractice - Admissions and the Medical Apology
- Sorry Works! Books for Christmas - just $24.99 per copy
SORRY WORKS! EDITORIAL: SAYING TOO MUCH TOO SOON AND OFF- HANDED COMMENTS
At Sorry Works! we strive to teach providers to tell the truth, even when something goes horribly wrong and errors were the culprit. Thankfully, providers and insurers are starting to embrace this message, however, we occasionally hear of doctors & nurses who embrace the message a little too much and/or like to jump the gun.
One of our prime themes at Sorry Works! is teaching providers exactly what patients/families want post-adverse event: The truth, the whole truth, and nothing but the truth. Accepting blame where blame is not assignable (or needed) is NOT the truth. Speculating is NOT the truth. Falling on your sword prematurely is NOT the truth. At Sorry Works! we will NEVER teach or coach a doctor or nurse to admit fault or accept blame when they truly believe no error occurred. We always coach to wait for the results of an investigation before admitting anything. However, there are many stories out there of providers who accepted blame or apologized when an adverse event was just that....an adverse event with no error. We hear stories of providers who think they are telling patients/families what they want to hear (I'm sorry, a mistake happened), when in fact a mistake has not occurred and the off-handed comment deepens the confusion and anger felt by the family - and heightens the chances of litigation!!
Time out!
At Sorry Works! we teach a three-step disclosure method, and the first step which is most-often deployed immediately following the adverse event is strictly empathy & good customer service: "I am sorry this happened...I feel bad for you and your family. We're going to do an investigation to figure out what exactly happened and have some initial answers in no more than 48 hours. In the meanwhile, is there anything we can do for you....do you need lodging, can we help make phone calls, do you need a minister?"
This is all that is necessary in the aftermath of most adverse events....this is all most patients/families want to hear: That someone cares and someone is in control of the situation and will get them credible/believable answers in a reasonable time frame.
Of course, to make Step 1 - and the two other steps - a success everytime, it helps to have a robust disclosure program in place. Such a program will provide training for providers and associated staff well-before any single adverse event. A robust disclosure program will have full-time staff who can & will assist providers through all the steps of the disclosure process.
FIFTEEN (15) SORRY WORKS! PRESENTATIONS ALREADY BOOKED JANUARY THROUGH APRIL
The New Year is still over three weeks away, but 2009 is shaping up to be a busy year for Sorry Works! Presentations. Already, in January through April we have 15 presentations booked for hospitals, associations, insurers, major medical groups, and long-term care providers. However, there are still plenty of openings left on the Sorry Works! calendar, but they won't be there forever. So, if you are interested in a Sorry Works! presentation - which count for CME/CEU credits - for Grand Rounds, keynote presentations, leadership, association meetings, ethics seminars, etc, please e-mail doug@sorryworks.net or call 618-559-8168. Call or e-mail...today!
ARTICLE & COMMENTARY: MALPRACTICE - ADMISSION AND THE MEDICAL APOLOGY
Below is an interesting article about apology and admission of fault. The example offered toward the end of the article ties in with our editorial above about off-handed comments and telling patients/families what you think they want to hear - when what they need is the truth as the truth comes into focus.
Our one big qualm with this article is it written without any mention of offering an apology in the realm of a robust disclosure program which includes pro-active means to address economic and non- economic needs of a patient/family. Consider this line from the opening of the article: "But other times, such an admission could result in a slam-dunk malpractice case against you. So it's best to know what to say and how to say it." Of course, if there are no means to address the needs of the injury party, then, sure the patient/family is literally forced to file a lawsuit and the case may or may not settle quickly depending on the attorneys involved.
Disclosure programs are so important because they provide the framework to include problem solving solutions within an apology, which is often as important as "sorry."
Also, consider this seemingly goofy line from the article: "In some states, such an apology is perfectly acceptable; in others, it's an admission against interest and evidence of malpractice." Let's be clear: Apology is perfectly acceptable and perfectly necessary in every state in the Union, Canada, Australia, UK, and elsewhere around the globe. Again, the trick is having a disclosure program in place so even if you do get sued after disclosing, apologizing, and offering compensation, your defense counsel is only arguing the case only on the damages. At the minimum, disclosure & apology provides great evidence for a defense, but most often times they eliminate the need for litigation in the first place!
Malpractice: Admissions and the Medical Apology
Alan G. Williams, JD, for HealthLeaders Media
October 16, 2008
If a police officer pulls you over—and you both know full well you were speeding—he or she typically asks, "Do you know why I stopped you?" The officer is trying to elicit an admission of guilt from you, such as, "But officer, I was only going eight miles over the limit." That is self-incrimination, and as Miranda makes clear, you have the right to remain silent because what you say can and will be used against you.
Although medical malpractice lawsuits are civil and not criminal proceedings, sometimes admitting what you did wrong may prevent a medical malpractice claim.
But other times, such an admission could result in a slam-dunk malpractice case against you. So it's best to know what to say and how to say it.
The medical apology
Although some providers disagree with offering a medical apology after an adverse incident, hospitals, medical centers, risk managers, and malpractice insurers increasingly recommend it.
A study published in the Journal of the American Medical Association concluded that subsequent to committing medical mistakes that harmed patients, providers were not providing the information and emotional support those patients needed, and that failure resulted in an increased likelihood of a malpractice claim.
After any questionable event, try to be open, honest, communicative, and understanding while making yourself fully available to the patient and/or his or her family.
The medical apology has four components:
- The acknowledgment includes details of the event, the persons involved, and the unacceptable nature of the behavior.
- The explanation is the exact reasons for the event. (Stating there is no explanation yet is acceptable.)
- Remorse is the genuine expression of contrition; if the expression is false or simply a pretense, the listener will sense it, and the apology will do more harm than good.
- Reparation is an attempt to make things right, even in a small way.
In some states, such an apology is perfectly acceptable; in others, it's an admission against interest and evidence of malpractice. Your malpractice insurer or risk management department can provide guidance on your state's laws.
Real-world case study
An elderly patient presented to the hospital for major abdominal surgery performed by an attending surgeon. The procedure was successful. After seeing the patient on the first post-op day and noting recovery was progressing normally, the attending surgeon proceeded with a planned vacation.
On the second and third post-op days, the nurses observed a gradual deterioration of the patient's condition, which they recorded in their notes and verbally alerted the covering attending surgeon. On the fourth post-op day, the patient continued to deteriorate, and the covering attending surgeon finally called the vacationing attending surgeon, who made some general inquiries but did not further contribute to the patient's care. On the sixth day, the patient crashed and died the next day.
The attending surgeon returned home, met with the family, apologized, and said, "This never should have happened. It's my fault for not returning early to take care of her and for not ensuring she was in good hands when I left. This was a mistake that could have and should have been avoided."
The attending surgeon later told me he said these things to appease and comfort the family, although he did not believe he or any other healthcare provider committed malpractice. But in the resulting lawsuit, the attending surgeon, covering attending surgeon, nurses, and hospital were all forced to settle.
The attending surgeon's statements implicated the entire medical team caring for the patient; each healthcare provider involved in the patient's care was held legally responsible in some way. (This incident took place in Florida, where a physician's apologetic statements are considered an admission against interest and can be used as evidence of malpractice.)
Alan G. Williams, JD, is the author of Physician, Protect Thyself: 7 Simple Ways NOT to Get Sued for Medical Malpractice and an attorney with Physicians MedicaLegal Prevention in Orange Park, FL. This article originally ran in the September issue of Private Practice Success, a HealthLeader's Media publication.
SORRY WORKS! BOOKS FOR CHRISTMAS - JUST $24.99 PER COPY
Hard to believe it, but Christmas is here. With a tight economy you'll need to find reasonably priced gifts for the healthcare, insurance, and legal professionals on your list. Enter the Sorry Works! Book. For $24.99 per copy, you can provide the "how-to" manual on disclosure and apology. However, the book is only 103 pages in length, so even the busiest doctor or lawyer can read it on a plane ride or over a weekend. The book also includes a stylish bookmark with disclosure tips.
Bulk discounts are available for large orders.
You won't find a more meaningful gift or more appreciated gift for the price. To order individual copies visit this link: http://www.sorryworks.net/booksoon.phtml. To make a bulk purchase, e-mail doug@sorryworks.net or call 618- 559-8168.
Merry Christmas!
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