When Rahul Shah, MD, then a pediatric otolaryngologist at Children’s Hospital in Boston, and several colleagues first undertook a survey of otolaryngologists’ reactions to adverse events in 2004, they provided a blank form for respondents to write about what had happened. In the more than 200 responses they received, Dr. Shah and his colleagues read an outpouring of emotion.
Explore this issue:July 2010
“It was cathartic for everyone who responded, like they had wanted to tell someone before but couldn’t,” said Dr. Shah, now on the pediatric otolaryngology faculty at Children’s National Medical Center in Washington, D.C. “They’d write things like, ‘This has been bugging me for years.’ They wanted to discuss the aftermath of adverse events in a peer fashion with colleagues but felt uncomfortable talking about these things with someone who knew them. We were nobody to them, so they could tell us.”
For years, adverse events in medicine resulted in a response similar to the one applied to gays in the military: “Don’t ask, don’t tell.” “The old attitude was that you couldn’t tell the patient anything, or they’d sue you,” said Brian Nussenbaum, MD, professor of otolaryngology and patient safety officer for the otolaryngology department at Washington University in St. Louis. “It placed an element of distrust between physicians and the public.”
And it’s not just the patient who suffers after an adverse event. Clinicians who have experienced a serious patient safety incident face their own demons. “It’s very common for clinicians to experience emotional distress following significant adverse events and errors. That distress has significant consequences, ranging from losing sleep and lack of confidence in your own clinical skills to difficulty focusing on meeting the needs of your patients,” said Tom Gallagher, MD, an associate professor of medicine at the University of Washington in Seattle and a nationally known expert on medical errors and disclosure.
In recent years, led by vanguard institutions like the University of Michigan and the University of Illinois at Chicago, this attitude has begun to change. Research has shown that patients and families who experience an adverse event are, in fact, much less likely to sue a doctor or a hospital that admits fault in an incident and expresses a sincere apology. At the University of Michigan, for example, the medical error disclosure program brought litigation costs down to $1 million from $3 million between 2001 and 2005, and annual claims and lawsuits were reduced by more than half, from 261 to 114, according to a report in the Journal of Health & Life Sciences Law (2010;2(2):125-1569). And as Timothy McDonald, chief safety officer at the University of Illinois, told the Wall Street Journal on Aug. 25, when the university introduced a similar program in 2004, lawsuits dropped by 40 percent over the next five years, even as the number of procedures went up.
—Jo Shapiro, MD
Washington University’s primary hospital, Barnes-Jewish, is now in the process of establishing a disclosure coaching program that will be accessible through a hotline number.