Monday, March 05, 2007

You don't have to say you're sorry

You don't have to say you're sorry
But I sure do wish you would, I wish you would
(With apologies to Vanessa Williams)

My recent posting on malpractice cases prompted several comments to the effect that, if doctors did a better job disclosing errors and apologizing for mistakes, there would be fewer malpractice claims. That issue has been debated back and forth for some time, and it is difficult to prove one way or the other.

The Harvard hospitals, under the guidance of Dr. Lucien Leape, have endorsed general principles that could result in more disclosures and apologies when medical errors are made, but it will be up to each hospital and ultimately the hundreds of physicians therein to decide how to operationalize these principles. Similar discussions are going on around the country.

In the meantime comes a thoughtful and useful program at Mt. Auburn Hospital, in Cambridge, MA. The folks at Mt. Auburn noticed that individual doctors and nurses were often unsure if a given situation merited a disclosure and/or an apology and, if so, how to most compassionately and effectively deliver it. So, they created a team of administrators and doctors who are on call to help a doctor or nurse who might have committed an error. This team eliminates the isolation felt by a doctor or nurse in that uncomfortable and awkward position; provides a third-party perspective on the particular case; and can often make helpful suggestions of how to talk with the patient and family members.

We are currently reviewing the Mt. Auburn program to see if it or some variant would be helpful to our care providers and thereby to our patients and families. If you know of a similar program, I would be interested in learning about it.

6 comments:

Brian White said...

Michigan Health System has a simlar team and a model system for dealing with what to do when something bad happens. See http://www.acpenet.org/MembersOnly/pejournal/2006/March_April/Articles/2Weber.pdf

Maxine said...

I don't know of other programs, but I have heard people comment many times that someone who had hurt them "never even said he was sorry" I think it would go a long way to ease relations. As a matter of fact, I recently wrote the MBTA about something similar. whenever they announce a problem, they say "Please pardon the inconvenience." Since I have no other choice but to stay on, get off or whatever and be inconvenienced, I can't pardon it. But if they said "We apologize for inconveniencing you." it might take the edge off.
Saying you're sorry is not a sin

Anonymous said...

The Sorry Works! Coalition has done a great deal of education and research in this area.

They're at www.sorryworks.net.

Anonymous said...

A sorry would definately help. My OB scalped my baby's head during my c-section...I received an off the cuff 'sorry' while I was still heavily medicated, and that's all. Luckily the baby just needed a few stitches, and the only lingering problem is a scar. I was angry enough to consider litigation at the time, because I don't know what else is going to make this doctor more careful in the future. Statute of limitations has not run out yet and I think it would be a petty lawsuit - it COULD have been a bad situation, but does that warrant a malpractice suit? I waffle on that...and just hope this OB learned - I chose another OB for my next pregnancy.

Teronni said...

I'm a medical student who used to work in OB. I think about this a lot. I saw physicians struggle with what to say when things went poorly, and I know that I will soon be in those shoes. I would like permission to be open and honest when I make a mistake someday. I knew physicians who felt really horrible when things went wrong, but didn't feel like they could apologize. They were told by risk management that apologizing was admitting fault and setting yourself up to lose a lawsuit. It would be great if the research said just the opposite. I would love to enter a profession that is allowed to be more honest.

Amuse said...

My husband is what some call a "gifted healer". For millenia, those of his profession have been made responsible by a system in which a patient whose treatment does not work is not required to pay. It's worth a moment's pause to consider to what extent the involvement of money in health care has led to damage of the physician's ego. What I mean is, we are not paid for being good human beings, but in ancient traditions, a healer is obliged by the very nature of his "supernatural" capacities to live in integrity, or he and the whole community suffer the consequences. Ring any bells?