Posts Tagged '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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