Posted on 11/11/2004 3:33:54 PM PST by freepatriot32
CHICAGO (Nov. 11) - It's a lesson children learn even before their ABCs - say you're sorry when you hurt someone. But it's now being taught in the grown-up world of medicine as a surprisingly powerful way to soothe patients and head off malpractice lawsuits.
Some malpractice-reform advocates say an apology can help doctors avoid getting sued, especially when combined with an upfront settlement offer.
The idea defies a long tradition in which doctors cultivated a Godlike image of infallibility and rarely owned up to their mistakes.
The softer approach, now appearing in some medical school courses and hospital policies, is drawing interest as national attention has turned to reducing both medical errors and the high cost of malpractice insurance, which has been blamed for driving doctors out of business.
Doctors' often-paternalistic relationship with patients is giving way to an understanding that "it's OK to tell the patient the whole story," said Dr. Paul Barach, an anesthesiologist and patient safety researcher at the University of Miami. It is "a huge sea change as far as our relationships with patients."
The hospitals in the University of Michigan Health System have been encouraging doctors since 2002 to apologize for mistakes. The system's annual attorney fees have since dropped from $3 million to $1 million, and malpractice lawsuits and notices of intent to sue have fallen from 262 filed in 2001 to about 130 per year, said Rick Boothman, a former trial attorney who launched the practice there.
Bob Vogt, a retired Cadillac dealership employee from Belleville, said an apology might not have stopped him from suing over the misdiagnosis of a brain aneurysm in 1990 that he contends left his wife severely disabled. But it might have saved his relationship with the doctor, once a close friend, he said.
"If he had come forward and not tried to conceal the thing, I probably would have had a lot better feeling," Vogt said. "You don't want them to be Godlike. They have to be willing to step up to the plate and say, 'I made a mistake."'
Dr. Michael Woods, a Colorado surgeon and author of "Healing Words: The Power of Apology in Medicine," said his own experience a decade ago illustrates the impact of the traditional way doctors have handled mistakes.
Woods was overseeing surgery to remove a patient's appendix. A medical resident accidentally punctured an artery, which led to a more extensive operation. The patient was unhappy with how Woods handled the aftermath; during one visit, Woods propped his feet up on the desk and, in her opinion, acted as if he didn't care.
Woods said he wanted to apologize, but legal advisers recommended breaking off contact with the patient when she threatened to sue.
Now a consultant to doctors and the malpractice insurance industry, Woods said his research has shown that being upset with a doctor's behavior often plays a bigger role than the error itself in patients' decisions to sue.
The say-you're-sorry movement has been prompted in part by emerging evidence about the scope of medical errors. An Institute of Medicine report in 1999 said mistakes kill as many as 98,000 hospitalized Americans each year.
Supporters of the strategy want the Illinois Legislature to adopt a program called "Sorry Works" that recommends apologies and settlements when mistakes occur. Under the proposed pilot program, two Illinois hospitals would be recruited to see if the policy saves money.
While the number of settlements would probably increase, lawsuits and sky-high jury awards would decrease, said Doug Wojcieszak, a public relations consultant whose victims' rights group proposed "Sorry Works."
Apologies and upfront financial offers could mean the difference between settlements costing thousands of dollars and drawn-out malpractice lawsuits costing millions in attorney fees and jury awards, Wojcieszak said.
The idea for "Sorry Works" came from an honesty policy the Veterans Affairs hospital in Lexington, Ky., adopted in 1987 after two big malpractice cases cost the hospital over $1.5 million.
Dr. Steve Kraman, then the hospital's chief of staff, said he helped create the policy as an alternative to the traditional "shut up and fight" strategy. The center's liability costs subsequently dropped below those of comparable VA hospitals, he said.
"Not only was it the right thing to do, but over the long haul, we were saving money by doing things this way," he said.
Other than that, this approach might put John Edwards out of business.
Unless of course apologizing is seen as an admission of culpability, in which case the lawyer is on the phone as soon as the words "I'm sorry" are out of your mouth.
"Sorry" to a trial attorney means "Oh, we'll also take your house."
Sorry avoids trouble? Tell that to the Japanese of 1945! It is an admission of defeat.
When I was a baby, my pediatrician apologized to my mother for ignoring her concerns about my health by writing a letter to the editor of the local newspaper. He took full responsibility for what happened and said that he learned a very valuable lesson about listening to mothers because they know their children better than anyone. My mother didn't intend to sue him, but his public apology made her feel much better and it restored her respect for him.
But if a doctor is going to be sued, then he's going to get sued. What's he got to lose by saying sorry?
Is that why nurses are constantly saying "I'm Sorry" everytime they rip off bandages or jab you with a needle the size of a screwdriver?? Ok a little exagerrated, but you get the picture!
A couple of days ago I was being treated at the VA clinic for a spider bite at my eyebrow - while I gritted my teeth, and cursed under my breath, and almost had tears running down my face, the doctor just kept saying "I'm Sorry" and he squeezed even harder getting the poison out.
My only complaint about these nurses and doctors?? QUIT SAYING "I'M SORRY!!" it gets old after the 10th time in a 1/2 hour.
Au contraire.
Most, although not all, lawsuits are primarily motivated by the "They shouldn't be able to treat people like this" factor.
Most people sue, initially, more to get psychic satisfaction than to get the money.
I suspect that apologizing when you have actually made a mistake would greatly reduce lawsuits. It is also the right thing to do regardless of whether it reduces your chance of being sued.
I also suspect that part of the reason juries give massive awards is to puncture that same god-like attitude of doctors and attorneys.
As a physician (anesthesiologist) found this artical interesting. I think if an obvious mistake occurs, an apology would be appropriate. More often however, there is a bad outcome and only in retrospect does it appear that things perhaps should have been done differently. In situations such as these I think an honest discussion as to exactly what occured is the best approach. Demonstrate compassion but do not apologize simply because the outcome was bad or because a complication has occured.
The key word being honesty.
And I might add, simple, basic customer service.
I understood perfectly when a long scheduled, supposedly timing vital, pediatric cardiology test for my child had to be postponed because the cardiologist had a sudden emergency patient that day.
What was incomprehensible to me, was why the "vital test" could suddenly be postponed for six months to fit the cardiologists scheduling convenience...
Honesty in medicine...what a new and unusual concept!
"Most, although not all, lawsuits are primarily motivated by the "They shouldn't be able to treat people like this" factor. "
Agree. We HAD to find an atty just to try to find out WHY our son died in surgery. The god-like docs, maybe under orders from lawyers or maybe from hubris, took a cold how-can-you-ask-questions-of-ME approach!!!!
Yes, if we had gotten staight answers and a reasonable explanation, we would NOT have had to go to the litigation route. The process took three years of our lives: it could have taken an hour or two of their time to adequately and with understanding explain things, rather than try to cover up and act perfect. We spent those three years PRECISELY because "they shouldn't be able to treat people this way!" We had the guts, money (even in contingency cases, you have to pay expenses . . .) and intellect and will to do it -- on BEHALF of all those other patients who would not be ABLE to do anything about it!!
OUR ATTORNEY WAS COMPASSIONATE, UNDERSTANDING, AND ALL THE THINGS THE DOCS WERE NOT!!!
P.S. The hosp. attorney was also compassionate and understanding, when we settled in mediation. The hospital in that way apologized, the docs themselves never did . . .
"As a physician (anesthesiologist)"
I appreciate your sentiments.
In our case, the anesthesiologist was drinking coffee while our 1 mo. old died under the care of the resident . . .
In the "conference" where it was to be explained to us, we asked him about his role, and he assured us he was "directly supervising the resident."
The conference was tense and fishy. So we got the records. My sister is a nurse. She saw on the chart "stat Dr. so-and-so to Room #". Of course, to her, that meant that HE HAD NOT BEEN THERE!. We were clueless until she read the charts! We BELIEVED them! I put my baby into HIS arms -- he told me, the baby would likely not even need to be on the ventilator over night, he was so big and strong. I said "just make sure he wakes up again." Which he did NOT do, finding reading his mail and drinking coffee (which he admitted under deposition, NOT in the conference which was to explain it all to us!!!) MORE important than being there! And the resident, thinking she could figure things out, called STAT TOO LATE!
Well, this anesthesiologist ruined his resident's career also! I found out later, she was doing out-patient work. It was undoubtedly a shock to her, too, to lose our baby. I saw her when she was pregnant, at the hospital where I went for my next baby. (She didn't trust her old hosp. either, apparently!!) She wouldn't do surgery any more . . .
One of our expert anesthesiologists said, based on the charts and the signs, if the real anesthesiologist had been there, he could have straightened things out. That is why they make $200K a year, he said. Like a pilot: mostly boring, but seconds of terror that you are trained to confront and fix. THAT is why we put the baby in HIS arms, not the novice resident's . . .
So the new doc's career was ruined by this, too . . . I feel he betrayed her as he betrayed us . . .
My sincere sympathy for your loss.
I've seen this repeatedly, although usually through being involved with property claims against insurance companies. People initiate and pursue a lawsuit most of the time because they are so infuriated by the way they've been treated.
There are, of course, professional litigants who are the exception to the rule, and I've run across them too.
On the other hand, it makes sense. One of the elders at my church is a ear, nose, and throat doctor. He tells me that he's never been sued, and he's not worried about it happening because he has a policy of complete honesty with his patients. If something goes wrong, he will tell them as soon as he can. If he screwed up, he will apologize. He says that he's never seen a malpractice suit filed when the doctor did that.
BTTT
"People initiate and pursue a lawsuit most of the time because they are so infuriated by the way they've been treated. "
Exactly: and to send a wake-up call, so that other people in the future are not treated that way. The hospital will have to take notice, evaluate their procedures, etc. . . . I don't think I could have gone through the three years it took, if I had not thought, maybe it was US this happened to, because we can do something about it, so that hopefully it won't happen again to someone else . . .
Thank you, sincerely, for your sympathy.
No wonder people sue.
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