Search Results for 'apologies'

More Evidence for the Positives of Apologies

Those of us who work in patient empowerment couldn’t help but notice the results of a Harvard Medical School study released this week about what happens to a relationship between doctor and patient when the physician makes an error. The story was reported in US News and World Report the New York Times and other outlets.

Originally published in the New England Journal of Medicine (NEJM), the commentary called Guilty, Afraid and Alone: Struggling with Medical Error basically says that when a doctor commits an error against a patient, trust is eroded and doctors feel guilty. (Did anyone question this?)

Turns out that in many cases, the patient’s family members feel guilty, too, for not protecting their loved one. Even nurses who lost family members to medical errors reported feeling isolated, and fearing their loved one was going to receive substandard care due to the guilt of those who had imposed the errors. The words “fear” and “rude” and “mistreatment” polka dot the report.

What’s the bottom line? Once again we hear the benefits of apologies by those who have violated trust. Nothing new here at all. Groups like Sorry Works have been talking about this for years. Thirty-four states have enacted legislation to grease the skids. Those doctors who understand the dynamics, even for their wallets, are beginning to get the picture.

Test it here yourself. Another story published within days in Miami, about a 3-year old who died at the hands of medical test administrators — even though the family questioned the procedure. So very sad. And a good illustration of how we feel on the other end of the tragedy when responsibility is taken by the guilty party. Apologies are plentiful, restitution is being made. By the end of the story, you’ll feel bad for the offenders, too — although not nearly so sympathetic as you do for the family, of course.

Doctors and providers — please pay attention. Your patients truly need you to understand the guilt aspects of errors, and then step up to the plate. Your careers, and our health, depend on it.

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How Apologies Lead to Fixing

I’ve talked before about blamers and fixers. Here’s a way of looking at that concept that may make you a wiser patient.

One of the big questions about medical mistakes is whether practitioners should own up to them. Until recently, doctors were highly discouraged from admitting any kinds of problems had taken place, whether it was prescribing the wrong medications or amputating the wrong limb. The thought was that by admitting guilt, they would be setting themselves up for losing lawsuits.

Once again — the concept of blame creates problems. The fix is what might seem surprising.

Studies have shown that in fact, when doctors are willing to accept responsibility enough to apologize, and review and learn from their mistakes, malpractice lawsuits are far less likely to be filed. In fact, a study undertaken at the University of Michigan Hospital where they have a policy of disclosure for both errors and near-misses, reflected a two-thirds reduction in medical malpractice claims, according to All Things Considered on NPR.

Clearly — taking responsibility can even save money!

What no one I know about has yet examined is this: why does that happen? Why can something as simple as a doctor’s apology keep a patient from filing a lawsuit?

Here’s my guess at the reason:

When young children misbehave, they are blamed for the problem they caused, then taught by their parents to apologize. The apologizing itself is deemed a way to begin the “getting beyond” whatever their indiscretion was, both for the misbehaver and for whomever the victim was. Also, as children, when someone hurts us or does something we know was wrong against us, we are taught to learn to accept an apology as the first step toward forgiveness. That’s how we learn the beginnings of closure, and we learn to depend on closure as the way to get over whatever happened.

Later, when something bad happens to us that we have no control over, we human beings want to blame. It gives us something to focus on. We blame the terrorists for 9/11. We blame the government for Katrina problems. We blame faulty design for the Challenger blowing up. Sometimes we even blame God, or whomever we revere, when something horrible happens that we can’t point any other finger at.

Often, that finger-pointing blame is appropriate. Who or whatever we blame deserves it, and what we want is for the object of our blame to then feel appropriately guilty — and therefore to apologize. The acceptance of that guilt is what lets us begin the closure process. Any healing that may take place will be based on that closure.

The Institute of Medicine tells us up to 98,000 Americans are killed by medical errors or misdiagnosis each year — which means 98,000 doctors deserve the blame. When those 98,000 doctors were told they were not allowed to apologize, then families of the victims had no way to begin their closure process by accepting an apology and starting to forgive. They needed to find closure in some other way. So they filed lawsuits.

That the number of malpractice lawsuits were reduced to one-third of previous levels because doctors are allowed to apologize, should therefore come as no surprise. In fact, in the NPR story used to illustrate the point, not only did the victim of the medical error feel relieved that she had been apologized to, but she further stated that she felt as if they had listened to her, and had learned from the mistake made on her, so that another woman wouldn’t suffer later from the same mistake.  She no longer felt like a victim.  In fact she felt like she had inspired something very positive.

The NPR story said that up to 70 percent of hospitals are now leaning in the direction of disclosure and apologies. That’s excellent. I hope to hear soon that 100% of hospitals are buying in.

And what can patients do in the meantime?

In my opinion, we can measure how patient-centered a hospital is by examining its policy about error disclosure. If they support disclosure, and allow their doctors to apologize and learn from errors, then they are far more likely to be interested in outcomes for patients than those hospitals that don’t support this sort of transparency.

So, taking this idea another step: as patients, if we think we may need to be hospitalized in the near future, we can actually use this information to our advantage. Call the hospital and ask what their policy is. Ask a doctor who has an affiliation at that hospital what their policy is.

Are they forthcoming and pro-learning? Or are they offended that you asked the question so they dance around the answer?

See what they respond, and how they respond. Tune in to their attitude. It can tell you a lot. And that might make a huge difference in your hospital experience.

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Learn more about doctor’s apologies here.

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From the desk of…. (11/2/07)

Some miscellany from the week not requiring entire blog posts on their own…fromthedeskof.gif

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Enjoyed participating in the WSYR Radiothon with Joe Galuski to raise money for the University Hospital / Children’s Hospital in Syracuse, NY. Incredible resource for families with sick children.

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Two good interviews of note on this week’s radio show: Dr. Thomas Welch, chair of pediatrics of University Hospital, and Dr. Matthew Scuderi who will talk about cartilage repair for the knee. You can download the interviews from the radio show website.

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You might be interested in some recent comments made by Marc J, an anesthesiologist, who is NOT happy with some of my posts. In fact, he would like to serve me some “salsa for the chip on my shoulder.” Hmmm…. He also suggested in one of the comments that he didn’t like attacking me on my blog where all my readers could see them — however — as you know, my email address is listed directly under my photo.

I want you, my reader, to understand all sides of the story when it comes to your care. In fact, I think it makes for smarter healthcare consumers — and shows you even better why you need to take responsibility for your own choices in your care, ranging from who your doctors will be, to how you will be diagnosed or treated, to how you will pay for your care, and everything in between.

So here are a list of Marc’s posts, although, please keep in mind that he doesn’t really intend to attack me publicly (uh-huh.)

Comment on Lemon Law for Medical Consumers by Marc J

Comment on How Apologies Lead to Fixing by Marc J

Comment on When Dirty Doctors Can’t be Identified by Marc J

In fact, Marc, you are right. There are definitely times I cop an attitude or have an “edge” to my work. I’ve been accused of that before. It started with my own misdiagnosis, and it continues because I get dozens of emails each week from people who have been wronged by the healthcare system in some way. It’s heartbreaking — and has turned me into a cynic, whereas throughout my life to this point, I’ve mostly been a pollyanna.

Guess that makes me the Ralph Nader of the healthcare system.

And yes, I have real problems sleeping at night. Because I just can’t get the word out fast enough.

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OK — out to do some gardening today! It’s a perfectly glorious autumn day here and I plan to take advantage of it. Included will be cleaning up the pieces of pumpkins left from the squirrels who have eaten right through them!

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Blamers and Fixers: Which One Are You?

You’d be amazed at the email and postal mail I receive from patients who have been hurt by the medical system. Perhaps not at the numbers — I receive a handful each week. Instead, you’d be amazed at what they ask me to do.

I’ve put the people who write to me about medical errors they have suffered into two categories: The Blamers and the Fixers

The Blamers are those who livid-angry, and they ask me to do things that will help distribute their anger further. They want me to help them write letters to doctors or hospitals or others who have wronged them. They want me to help yank a doctor’s license to practice, or help them sue a provider, or participate in whatever form of punishment they believe is appropriate. In one case, the Blamer was a whistle-blower, and she wanted me to begin publishing her work on this blog or in my columns to bring attention to the plight of whistle-blowers (because no one is paying attention to her own blog.) Another lost both parents to hospital infections. In another case, a man wanted me to publicize his story about the towel that was left in him during surgery because the lawsuit dollars being proposed just weren’t big enough.

Their anger is just so palpable. And I get it! I was there! After my misdiagnosis, I talked to anyone who wanted to listen in hopes it would somehow diffuse my anger.

It didn’t.

My guess is that in many cases, these are people who have been so wronged by the system, that they are grasping desperately for something to fix the wrong. Of course, it can rarely be fixed. Apologies can’t fix the hurt, frustration and pain. They think that punishing the wrong-doers will fix it.

It won’t.

The Fixers are a step beyond. Fixers are people who have been hurt by the system, and have turned that bad experience into something else more positive.

Among my advocate-colleagues, you’d be amazed at how many of us are fixers. Very few have just chosen to take up the cause of patient advocacy out of the blue. Instead, their children have been killed by bad surgeries, or they’ve lost a spouse or parent to a medical error, or a diagnosis has been missed (or misdiagnosed all together) and someone they love — or they themselves — have been treated incorrectly.

The Fixing itself becomes the catharsis for the anger, and it is extremely powerful. Helen Haskell, Ilene Corina, Patty Skolnik, Julia Shopick, Bill Thiel — among many others — are all fixers. They lost children and spouses to a system that didn’t do what it was supposed to do.

In some cases, their work is a spiritual mission. In others, it’s simply their way of dealing with anger. In all cases, they took their anger and sadness and refocused it toward something positive.

I am a Fixer. And I am proud of it.

We, the Fixers, are working toward improving the system that caused us the anger to begin with. We put our voices together and patients and providers are hearing us! We are saving lives with our work. There is NOTHING more powerful, nor cathartic, than saving someone else’s life.

If you find this blog post and you are still one of the Angry Ones, a Blamer, then please consider becoming a Fixer. I promise you, it will make ALL the difference in your quality of life.

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See follow up post: Doctors are Blamers or Fixers, too

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Did My Doctors Apologize?

Since my post yesterday about the article in the Chicago Tribune about doctors apologizing, a handful of readers have sent me an email asking whether the doctors involved in my misdiagnosis debacle ever apologized to me.

Good question!  and the answer is yes… and no…. Truth is, I didn’t give them much choice.

There were three doctors I held accountable for my misdiagnosis and resulting almost-treatment fiasco.  At the end of my odyssey, I wrote a long memo to all the doctors involved in the process — the good guys and the bad guys.  It was addressed to the mistaken ones, and copied to the others.

The three I was most upset with were the two pathologists and one oncologist.  If you’ve read my story, you know I was told that that two different labs had confirmed my diagnosis of a rare, aggressive lymphoma — as I understood it — one lab reviewed the biopsy, then forwarded it to another lab for a second opinion.  From there, the information was forwarded to the oncologists. 

So here’s how each responded:

Pathologist #1 is Doctor E.  She heads up the first lab that looked at my biopsy and when I followed up my memo by phone about 10 days later, I did have a good discussion with her.  She did apologize for the mistake.  She also told me about the protocol used to transfer a case from one lab to another, because I couldn’t understand how two labs could get it wrong.  It turns out that “transfer protocol” calls for lab #1 to tell lab #2 what their conclusion is, i.e. “Here’s a speciman.  We think it’s X.  What do you think?”

OK — how many of you took basic science in 6th grade?  Do you remember learning about blind studies?  I almost fell down when Dr. E told me what the protocol was.  Clearly, there is NO request for an objective second opinion!  All the second lab is being asked is whether they can confirm the diagnosis — they are not being asked for a second opinion.  And the mere suggestion of a certain diagnosis then influences the confirmation.  There is nothing objective about it at all.

Pathologist #2 is Doctor R.  He heads up the second lab that took a look at my biopsy and confirmed the same as lab #1.  He was actually quite open about how the mistake had been made and I learned two things from him. 

First, he blamed the fact that because my biopsy had arrived at the lab on July 1, a weekend and the start of the July 4th holiday, they had nobody in the lab with enough experience to review such an unusual biopsy.  (Take note — no matter how much the health literature written by doctors will tell you this isn’t true — when it comes to any kind of elective healthcare, always avoid summer holidays and end-of-the year holidays if you can!) 

Second, he told me that in med school, he was taught that no doctor is perfect;  to expect to make mistakes.  But if a mistake had to be made, always err on the side of making sure someone WILL be treated rather than erring on the side of not treating a patient who needs it.  OK.  As much as they ended up being a nightmare for me, I can buy that.

The oncologist – Dr. H — was another story.  In the memo I sent to all the doctors, I most chastised him, and suggested — no, accused — him of insisting I begin chemo because it was the only way he could make money off me.  Surprisingly, he never even replied to that accusation (and it still stands, as far as I’m concerned.)  However, what he did do was send me a three page letter, coming down on ME for “unfairly impugning my professional reputation.”  He went on to explain why he had been RIGHT to insist I begin chemo (when there was plenty of evidence pointing to a possible misdiagnosis.) 

I sent a reply to Dr. H, pointing out that, in fact, he had been the one to err, not me, and if anyone was impugning anything, it was him.  I also stated that I was only looking for apologies, and for a zero balance on my account (why should I pay for their mistakes?) and was not intending to file any official complaints or lawsuits.

A few weeks later, I received a follow up letter from Dr. H., with a kinda-sorta apology, phrased like this, “I’m sorry if you were unhappy with your experience with me.” 

Yeah, OK.

So that’s the story. For those of you who read this blog regularly, or read my columns or listen to my radio show, you know I don’t dwell on any of it.  I use my misdiagnosis as the springboard for my work — but dwelling on the details isn’t something that moves anyone forward except as the details present good examples for the points I try to make for sharp patienting.

And perhaps that’s the whole point about extracting an apology from a healthcare provider who has wronged us.  When we know that someone else has recognized a mistake, and truly feels bad that it has happened, then we ourselves can begin to move on.  It’s a form of closure.  It allows us to begin putting the situation behind us to deal with whatever our new reality is.

My advice to patients about doctor apologies is this:  if you know you’ve been the victim of any form of medical error, and you don’t see those providers involved stepping up to the plate — then ask them to!  If it makes the squirm?  Well — that’s THEIR problem, not yours. 

Insist they own up to their mistakes.  If that involves an apology, so be it.  And if you have to be tough, even bitchy — then go for it.  Because at the end of the day, YOU are the one who must move on.  And insisting someone else take responsibilty for the actions that YOU must pay for can be very empowering.

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P.S.  to the Joint Commission:  there was nothing “unanticipated” about the outcome of the mistakes made by these doctors.  Nothing at all.  The only thing unanticipated was how I would react by being misdiagnosed.  I dare say none of the doctors involved ever thought I would change careers to help right the ship of our failed American healthcare system, now did they?

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Doctors: Apologize for Euphemistic Unanticipated Outcomes

Doctors at the University of Illinois Chicago Medical Center are being encouraged to admit medical mistakes and apologize to their patients, so states an article by Judith Graham, published in this week’s Chicago Tribune.

Good! And I can’t state that strongly enough.

I’ll add, it’s about time, so what took so long, and one down — what about the other 6,499 hospitals in the US?  (OK, a few encourage apologies — see below.)

Ms. Graham did an excellent job with the article.  She presents the many aspects of the history of physician apologies, why doctors have, or haven’t, apologized over time, and provides very substantive quotes from various experts in the field.  In effect, egos and fear of retribution in the form of lawsuits have stood between physician mistakes and patient communication over time. 

No surprise there.

A few points stand out from the story — worthy of being shared.  First, that the Veterans Administration and hospitals affiliated with Harvard Medical School encourage their staffs to tell patients about errors, provide an apology — and (very importantly) explain what they will do in the future to prevent a similar mistake.  As someone who has been burned by a medical error, I can very much appreciate that approach.  I may have suffered, but I can feel a bit better about it if I know they will take steps to be sure it doesn’t happen again.

Second, that the Joint Commission on Accreditation of Healthcare Organizations (the group that oversees the credentials of hospitals, formerly called JCAHO) also encourages fessing up.  That’s good, too.

But in the midst of the Joint Commission’s recommendation, they have also developed a new euphemism for medical errors.  Honestly — this is so ridiculous, it made me laugh out loud!  God forbid we should call a medical error spade a spade — they now call them “unanticipated outcomes.” 

What a cop out!  Medical mistakes are not “unanticipated” outcomes at all!   Mistakes are just that — mistakes.  If a doctor makes an incision in the wrong place, there is nothing unanticipated about it — it’s just a mistake.  If a doctor prescribes the wrong drug or the wrong dose of the right drug, there is nothing unanticipated about it — it was just plain wrong.  If a doctor misdiagnoses or orders the wrong treatment — it’s an error, plain and simple. If a doctor doesn’t stop to wash his hands, and his patient acquires an infection — c’mon — it’s not at all “unanticipated!”

And — when any provider makes a mistake, s/he can most certainly anticipate the outcome!  S/he can anticipate that it will cause a problem for the patient.  S/he can anticipate that the patient will take longer to heal — or might even die!  S/he can anticipate that the patient and his/her family will be upset.  And on and on.

OK — you’re right.  Nobody plans to make a mistake.  But that doesn’t mean the mistake was unanticipated.  No way.  So — Joint Commission — why don’t you call a medical error exactly what it is?  It’s a medical error!

All this reminds me of that book that came out about 20 years ago about everything I needed to know I learned in kindergarten.  My parents (and kindergarten teacher) taught me to be honest, to come clean about mistakes and above all, to apologize to the person I wronged.  I wasn’t allowed to use my fear of punishment as an excuse, and certainly I was never allowed to let my ego get in the way…. not a chance….

So, doctors — you have absolutely no reason to cover your backsides by non-communication and lack of apologies any longer.  Big name organizations are providing this message — no matter what they call a mistake or — excuse me — an unanticipated outcome — apologize and communicate! 

Patient trust is already tentative at best.  Non-communication is no longer acceptable, regardless of whether it’s your ego or your insurance company whispering in your ear.   Stop making excuses, stop covering up, stop pretending the consequences of your errors were “unanticipated.” 

Be human. Be apologetic. Be humble. Be available.  You’ll sleep better, too.

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Note:  see follow up post:  Did My Doctors Apologize?

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