Wednesday, June 26, 2013

medical errors: just say you’re sorry.

Honesty is an important virtue. But when the scariest two words in healthcare are on the line- malpractice lawsuit- it’s not just your virtue on the line but also possibly your career, reputations and lifetime’s worth of work. Admitting you made a mistake? That you did something wrong? Um, scary.

Picture: if you understand why this picture is here… you must be a musical geek.tumblr_lj9mmn3ih91qivatvo1_500

Most of us when we go to the dentist don’t understand what’s going on. I’m a dental student and I don’t fully understand the procedures I’m observing at times. Sitting in the chair, we don’t know what’s going on in our mouths, let alone see what’s being done there. So patients probably won’t know if/when their dentist makes a mistake… right?

According to a shocking report in 2001 by Institute of Medicine titled “To Err is Human”, a whooping 98,000 people are estimated to die annually from medical errors. This makes the average person more likely to die from medical errors than from car accidents. I was reading about malpractice and came upon this new (to me) concept for dealing with malpractice litigation: saying sorry. In this New York Times article “Doctors say ‘I’m sorry’”, this new approach of “promptly disclosing medical errors and offering earnest apologies and fair compensation” works to “restore integrity to dealing with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.”

This new model of early disclosure and offer (D&O) program was implemented at University of Michigan in 2001. A crucial tenet of this program is open conversation with patients, said to be a “radical departure from the traditional ‘deny and defend’ paradigm”. The hospital is ready to offer an apology and fair compensation if there’s been fault at administration of care.

Here are some concrete data for the success of The Michigan Model:

results-of-medical-error-disclosure-program-at-the-university-of-michigan-health-system

Recent numbers show a similar pattern: rate of lawsuits per 100,000 patients per months went from 2.13 suits to 0.75 in 2013. Median time for resolution dropped from 1.36 to 0.95 years (American College of Surgeons- March 2, 2013). Legal defense costs at UMHS dropped 61%.

In context of national spending, we can expect a decrease in direct costs (estimated to be $35 billion annually). Not only that, but also a $66 billion decrease in defensive medicine spendings- “increase [in] volume or intensity of healthcare services… to protect against possible lawsuits” (such as ordering computerized tomography instead of a simple X-ray)- Numbers from Congressional Budget Office “Tort Reform” Analysis, 2009).

UMichiganmalpractice1

Many patients sue because they feel it’s the only effective way to gain the hospitals’ attention- read this frightening account by Dr. Jonathan Welch about his own mother dying from medical errors. In his case a letter was ineffective in getting “an explanation for what happened… an apology… assurances that it would never makes these mistakes again.” He cites successful systems encouraging such conversation in places like UMich, they see “litigation as a last resort.”

One UMHS patient JW whose breast cancer was undiagnosed for months, went through such open conversation with her physician and the hospital. She described her outcome as below (from Journal of Health and Life Sciences Law, January 2009):

"”What that apology meant to me was that they had listened finally and I had been heard.”

She’s still a patient at UMHS.

A Penn dental alum told me the #1 rule to succeeding as a dentist: “Take care of your patients. Put them first above anything else.” Another professor in my clinic keeps reminding us: “If you make a mistake, tell them. They’ll trust you as a dentist and stick with you.” Not just for your own integrity but because honesty and humility works- we’ve got the data to prove it.

19 comments:

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