Home • Latest Med-Mal Insurance News & Research • Cg Ins • Healthcare Industry • Doctors try new word: Sorry.
“This is our responsibility, and we are very sorry for it,” Mehta said, recalling the conversation.
But the culture of secrecy in medicine is beginning to change, as leading patient safety organizations call for fuller disclosure of medical errors and some trend-setting hospitals decide an “honesty is best” policy will improve care.
Advocates say acknowledging medical errors can advance healing by defusing patients’ anger and easing physicians’ guilt, especially when accompanied by an apology. Some also contend the practice can cut back on malpractice lawsuits and payouts, though with the movement in its infancy it’s too soon to know for sure.
Supporters include influential industry groups such as the Joint Commission on Accreditation of Healthcare Organizations and the National Quality Forum, which now recommend all hospitals disclose serious “unanticipated outcomes” in medical care — bad things that shouldn’t have happened.
Chicago has become something of a center for the emerging “fess up” movement. The UIC Medical Center is nationally known for its comprehensive error disclosure program, and the university’s medical school has created a curriculum to train future doctors how to recognize and deal with mistakes.
“The goal is to maintain patients’ trust,” said Dr. Tim MacDonald, UIC’s associate chief medical officer for patient safety.
But significant barriers to saying “I’m sorry” remain. Many hospitals say they support disclosing errors but haven’t instituted comprehensive policies, O’Leary said.
Dr. David Mayer, an anesthesiologist and assistant dean for curriculum at UIC’s medical school, tells of an experience in the mid-1980s at a Chicago teaching hospital. A young man had come in for a hernia repair, and a surgical resident made the initial incision on the wrong side. The error was discovered quickly and corrected.
When Mayer visited the patient later, the man mentioned the doctors had told him they saw something suspicious on that side, went in to check and found nothing wrong. “I’m lucky,” Mayer recalls the patient saying.
Mayer was surprised but just nodded his head. “No one had ever talked to me about what to do when things don’t go as planned,” he said.
One of the biggest obstacles to disclosure is the fear of lawsuits. More than 30 states, including Illinois, have passed “apology laws” that prevent expressions of regret from being used against physicians in court. But most lawyers are skeptical and insurance companies typically still insist that doctors break off all communication with patients or families after medical snafus occur.
Kraman recalls the case of a middle-aged woman whose family was unaware that she had died from a medication error. “Our team asked, ‘Would we want to know the truth if this was our mother?’ and the answer was obvious,” he said.
As the attorney’s jaw dropped, the daughters expressed gratitude at being told the truth. A financial settlement was negotiated, and the hospital made several changes to prevent similar errors.
At UIC’s medical center, a wide-ranging disclosure program began about a year ago and is now considered a national model by many experts.
Offering financial assistance is part of the bargain. “The best way to approach this is to own up to the fact that an incident happened and ask what can we do to fix it and make the situation better,” said John DeNardo, UIC’s chief executive officer.
Things went wrong when Cephas received the injection at UIC’s oncology clinic, then went to the hospital because of severe pain chemotherapy was causing in her hands and feet. Cephas’ medical chart showed no record of the neulasta, and without discussing the matter with Cephas a resident ordered another shot.
Mehta, the head of oncology, learned of the double injection the next day, when someone from the hospital contacted the clinic. Before talking to Cephas, “I checked all the facts and I put myself in the shoes of the patient and asked myself what her concerns might be, so I could prepare truthful answers,” he said.
Cephas’ white blood cell count had soared, but the implications were unclear. While blood-cancer patients with high white-cell counts have experienced ruptured spleens, Mehta could find no research applicable to breast cancer.
Haskell repeatedly called for help, but hospital staff told her Lewis was constipated and had gas pains because of the painkillers he was taking. The residents — physicians in training — who saw the boy didn’t order a routine blood test that could have flagged the bleeding. Haskell’s urgent requests to have a senior physician examine her son were ignored.
When hospital staff couldn’t get a blood pressure reading, they assumed the monitor was malfunctioning and spent more than two hours repeating the test.
After Lewis’ death from cardiac arrest, his physician — who was not the senior doctor on call that weekend — told Haskell and her husband “this is our fault” and cried when he heard what had happened.
Their reaction? “We felt better. He was an honest man,” said Haskell.
Since her son’s death, Haskell has founded Mothers Against Medical Error and the Medical University of South Carolina has dedicated a chair in patient safety to her son.
“Helen inspires me and reminds me of what can happen when we don’t listen to the alarms raised by patients and their families,” said Dr. John Shaefer, the anesthesiologist who currently holds that post.
Without disclosure of medical errors, “there’s no learning from mistakes in institutions and the same things happen over and over again,” Haskell said.
This entry was posted in Healthcare Industry, Office Procedures, Patient Satisfaction, Physician Leadership, Practice Management on August 20, 2007 by dleander.