Experts Urge Building Support System Before Jumping on Apology Bandwagon: ‘Be Proactive, Not Reactive’

Mr. Key agreed that the tort system is broken, and that reform in the medical injury compensation system is needed so that disclosure of errors is encouraged rather than discouraged. But any reform must take into account that someone must compensate patients for injury and disability. In our zeal to fix these problems we’re talking about, we cannot lose sight of the fact that people do get injured in the course of receiving medical treatment, and that often these injuries were avoidable-thatwhy we need to learn from them, he said.

Dr. Shapiro added that being involved in errors often has an emotional impact on clinicians. Careful attention to support systems can help physicians address these underlying emotions and help ensure their continued professionalism.

Private Practitioners Can Replicate a Risk Management Department

UMHS Chief Risk Officer Richard C. Boothman concedes that it is tougher for otolaryngologists in group or private practice, in the community setting, to match the risk management resources of academic institutions or closed health systems. However, he and others interviewed for this article asserted that physicians can build their own commensurate support system to help address medical error situations.

Here is some of their collective advice:

• Plan for errors. Nobody wants to envision this situation [an error or preventable adverse event] happening, said attorney Michael Clark. But if you do enough business over time, even the best designed systems are going to fail-just because everybody is human. He advises being proactive and making plans ahead of time, instead of having to react and triage problems in real time.
• Establish a relationship with a defense attorney conversant in health care law. Set up a consultation and establish an agreement with the attorney, including him or her in your arsenal of other professional advisors. Recognize that stonewalling patients can set up a propensity to litigate, so ask the attorney to be available if you encounter trouble to help you navigate interactions with your insurance company and the patient and family.
• Set realistic expectations ahead of time. Surgeons have a discrete opportunity to do this, said Mr. Boothman. The physician who has the emotional maturity to tell the patient that the outcome is not guaranteed, but that he or she will be with the patient throughout the process, stands a far better chance of avoiding claims afterward.
• Encourage your hospital leadership to support clinicians. The Joint Commission requires transparency, noted Dr. Shapiro, and clinicians can voice that transparency is the right thing to do for patient care-but that clinicians must also be supported, because this is a hard thing to do.
• Consider an outside speaker. To help kick off transparency policy efforts, having an outside speaker can sometimes galvanize administrators as well as clinicians, said Dr. Shapiro. In this way, clinicians and institutions will learn that they are not alone in facing these troubling events.

Additional resource: The University of Michigan Health System makes available a patient safety toolkit, including an examination of the disclosure controversy, recommended reading, and other resources. Go to: www.med.umich.edu/patientsafetytoolkit .

References

1. Medical Malpractice and Patient Safety at UMHS, accessed June 30, 2008 from www.med.umich.edu/news/newsroom/mm.htm .
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2. Sack K. Doctors start to say ‘I’m sorry’ long before ‘See you in court.’ New York Times May 18, 2008:1, 17.
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3. Studdert DM, Mello MM, Gawande AA, et al. Disclosure of medical injury to patients: an improbable risk management strategy. Health Affairs 2007;26(1):215-26.
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4. Wojcieszak D, Banja J, Houk C. The Sorry Works! Coalition: making the case for full disclosure. Joint Commission Journal on Quality and Patient Safety 2006;32(6):344-50.
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©2008 The Triological Society