Doctors try a new word: Sorry.

[Chelee]

Tuesday, September 25, 2007
Doctors try a new word: Sorry

Fuller disclosure of errors is changing the culture of secrecy in medicine.

By JUDITH GRAHAM
Chicago Tribune

The doctor walked into the hospital room with a discomforting mission. He was there to admit a medical mistake and apologize to his patient, a woman with breast cancer.
The staff had given her the same injection twice by accident, causing her white cell count to soar, said Dr. Divyesh Mehta, chief of oncology at the University of Illinois at Chicago Medical Center. He recommended she stay in the hospital an extra day or two.
"This is our responsibility, and we are very sorry for it," Mehta said, recalling the conversation.
Not long ago, this encounter would have been almost unthinkable. Medical foul-ups were rarely discussed among physicians and almost never acknowledged to patients. Doctors were too proud, too afraid of malpractice lawsuits, too worried about losing face.
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 that 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.
The Veterans Affairs and hospitals affiliated with Harvard Medical School have gone further, urging staff to tell patients about errors, to apologize, and explain how they plan to prevent similar mistakes.
Chicago has become something of a center for the emerging "fess up" movement. The University of Illinois at Chicago 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, the University of Illinois at Chicago's associate chief medical officer for patient safety.
But although virtually all doctors say they want to be honest, fewer than half actually reveal serious errors in practice, according to an August 2006 study in the Archives of Internal Medicine.
"These are folks who were No. 1 in kindergarten," MacDonald said. "They're not used to admitting they did something wrong."

One of the biggest obstacles to disclosure is the fear of lawsuits.
More than 30 states 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 errors occur.
The fear, of course, is that any admission of wrongdoing could make it easier for patients to advance lawsuits.
The reverse argument is that patients will be less inclined to sue if doctors are forthright and hospitals offer reasonable compensation for injuries.
Some anecdotal evidence supports that view. Since 2001, when the University of Michigan Health System started acknowledging medical mistakes and offering prompt settlements to injured patients, the number of pending malpractice claims has decreased by almost two-thirds, according to chief risk officer Richard Boothman.
But in a study published this year, Harvard University researchers predicted that claims will proliferate as more patients become aware of errors. "Disclosure is the right thing to do," the researchers wrote in the journal Health Affairs, but its spread is "likely to amplify malpractice litigation."
Dr. Steven Kraman, who helped launch one of the first disclosure programs at the VA Medical Center in Lexington, Ky., is among those who believe the value of institutions learning from their mistakes outweighs the potential costs.
Kraman recalls the case of a middle-age 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.
The physician advised the daughters to bring an attorney to a meeting. "Your mother was quite sick; in trying to help her we gave her far too much medication," Kraman recalls telling them. "No one did this intentionally, but we've caused you a loss and we feel we owe you an explanation and compensation."
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 the University of Illinois at Chicago's medical center, a wide-ranging disclosure program began about a year ago and is now considered a national model by many experts.
When a patient suffers harm, a team of doctors, nurses, pharmacists and social workers is expected to investigate within 48 hours. If the team finds an error, doctors are to meet with the patient, explain what happened and apologize.
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, the university's chief executive.
In the first year, the hospital acknowledged 40 errors, and only one resulted in a malpractice claim, officials report.