Re: Hospitals study when to apologize to patients

Doctors are the only group of professionals in the world who have to be
'taught' how to apologize. We learn at our parents' knees to say 'I'm sorry'
to Timmy when we steal his toy, and then to give it back.

This article is saying that during medical training this knowledge is
drummed out of doctors. Geez, you'd think something that comes naturally
after 20-some years would be a little harder to eradicate! If it's that
easy, it almost sounds like they gave it up without a fight.

Wait, did I say doctors were the only ones? Add to that the salesman of the
landscape company who totalled my Land Rover last month! I'm still dealing
w/his insurance company. (Don't get me started on insurance companies!)
--
Shirley B.
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Dr. Johnetta B. Cole


"Cowboy" <msbuckaroo@xxxxxxxxxxx> wrote in message
news:1122296161.868730.103710@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
http://www.boston.com/business/articles/2005/07/24/hospitals_study_when_to_apologize_to_patients/

Hospitals study when to apologize to patients

By Liz Kowalczyk, Globe Staff | July 24, 2005

Harvard Medical School's major teaching hospitals are considering
adopting a sweeping disclosure policy that would establish detailed
procedures for physicians to openly acknowledge medical errors and
other bad results to their patients, and provide for training in
apologizing.

A group of physicians, patients, and executives from the hospitals, led
by Dr. Lucian Leape, a national specialist on patient safety, began
drafting the policy last year. In recent months, the group circulated a
50-page first draft among hospital leaders, who responded favorably to
its broad goals but have suggested numerous revisions, which the group
is now implementing.

If Harvard's largest teaching hospitals -- Massachusetts General
Hospital, Brigham and Women's Hospital, Beth Israel Deaconess Medical
Center, Dana-Farber Cancer Institute, and Children's Hospital Boston --
adopt the policy, it would create a uniform response across the Harvard
system to some of medicine's most difficult situations. The Harvard
hospitals also would join a growing number of US medical centers and
malpractice insurers that are embracing immediate and open disclosure
and apology to patients when medical care goes wrong.

''I'm trying to get all the Harvard hospitals to adopt the policy,"
said Leape, a professor at the Harvard School of Public Health. ''The
time has come to be open with our patients."

The policy states that patients should be compensated for expenses
related to medical injuries, said doctors who have read it. But those
involved in the project said they don't believe they can work out soon
an agreement about who should pay such expenses, and which expenses are
covered, so the group plans to leave out those details until after
further discussions.

The Harvard hospitals, as do most hospitals, already have their own
policies on dealing with unanticipated medical outcomes. The Joint
Commission on Accreditation of Healthcare Organizations, a national
group that reviews and accredits hospitals, requires hospital
caregivers to tell patients about the most serious of these situations,
but doesn't spell out requirements beyond that.

In Boston, Dana-Farber has one of the most detailed disclosure
policies, and requires doctors to apologize for errors. But the
ingredients of the Harvard hospitals' policies vary tremendously. And
implementation of the policies and training is spotty, said Robert
Hanscom, director of loss prevention for the Risk Management
Foundation, which insures Harvard hospital doctors.

''We have some hospitals that have moved forward very progressively,
but we've seen a couple of cases recently where there's been a real
hesitancy on the part of providers to have that conversation with
patients. It should happen within hours. We've seen delays of several
days," said Hanscom, who is a member of Leape's group.

Leape and other physicians developing the policy said disclosure is
''the right thing to do," but there also is growing belief among
malpractice insurers that such disclosure and open expression of
sympathy and remorse could head off malpractice lawsuits in a system
reeling from skyrocketing premiums.

''Doctors worry that if they talk to the patient, they're more likely
to be sued," Hanscom said. ''Our feeling is just the opposite. It's the
shutting down that angers patients. We've heard from patients in this
situation that everyone almost shuns them."

Colorado's largest malpractice insurer, COPIC, for example, has
enrolled 1,800 physicians in a disclosure program under which they
immediately express remorse to patients when medical care goes wrong
and describe in detail what happened. The insurer compensates patients
for related expenses, including insurance deductibles for follow-up
medical care; lost time at work; and baby sitters, said Dr. Jerome
Buckley, who helped develop the program. Patients cannot participate in
the program if they have filed a lawsuit, but they do not waive their
right to sue later, he said.

Cases in which an obvious error occurred, such as a surgeon amputating
the wrong leg, do not qualify for this program, Buckley said, because
they must by law be reported to regulatory boards and investigated
through traditional channels. But it does cover cases where patients
experience a known potential complication or poor outcome, or when it's
unclear that a bad outcome was caused by a physician's error.

Since 2000, COPIC has reimbursed more than 400 patients an average
$5,300 each for bad medical outcomes, or a total of about $2 million.

Buckley said malpractice claims against these 1,800 doctors have
dropped 50 percent since 2000, while the cost of settling these
doctors' claims has fallen 23 percent. The University of Michigan
Health System has cut claims in half and reduced settlements to $1.25
million from $3 million a year since developing a disclosure policy in
2002, said Richard Boothman, chief risk officer.

Last month, Buckley flew to Boston to speak to Risk Management
Foundation executives as part of development of the proposed Harvard
policy, and to executives from ProMutual Group, the state's largest
malpractice insurer.

Leape said he did not want to discuss his proposal in detail until it's
final.

But doctors who have reviewed it said that it addresses all aspects of
a poor medical outcome: the impact on the patient and family; the
impact on doctors and nurses; training for caregivers in handling these
events, including immediate response teams that would provide immediate
guidance on talking to patients and families; and the investigation of
such events and making changes to prevent future problems.

''Yes, we're recommending that doctors say they're sorry," said Dr.
Thomas Delbanco, of Beth Israel Deaconess and a member of Leape's
group. ''Be a human being. Don't just say it; mean it."

The policy would require approval from the hospitals' top executives
and in some cases trustees. ''A lot of details need to be worked out
before we could sign off on it," said Dr. Britain Nicholson, Mass.
General's chief medical officer. ''This would dramatically expand on
our policy."

Nicholson and leaders at other hospitals said they want language
clarified. For example, many bad outcomes are not errors; they are
known but rare complications. Do doctors apologize in these cases?
Should patients be compensated financially?

''If I am doing a colonoscopy and there is a perforation at a weak area
in the bowel wall, a physician would take umbrage if he or she had to
say 'I am sorry I made this error,' " said Nicholson.

He said doctors who reviewed the policy also want the section on
support for physicians and nurses involved in medical mishaps expanded;
possibilities are allowing these doctors paid time off and expanded
counseling and mental health benefits.

Nicholson said that at Mass. General disclosure of medical errors is
routine. But he said whether a doctor explicitly expresses remorse
varies. ''Part of it depends on when you went through training," he
said. ''Fifteen to 20 years ago coming through medical school and
residency, we were implicitly, if not explicitly, told, 'Don't ever
admit a mistake,' because it will come back to haunt you if you get
sued."
© Copyright 2005 The New York Times Company


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