Comments on: Doctors saying sorry to patients after medical errors is the right thing to do http://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: danihttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121563 dani Fri, 11 Dec 2009 03:10:03 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121563 I was refused medical help after an ER doctor put false information in my medical records.My condition had been life threatening before and after the spinal tap.This left me in a critical condition without medical help and a hospital was refusing me care.I was left with abnormal gait, a latency of speech, photo-phobic,weak,with an inflamed body and brain,drowsy and in a state of hyperventilation.Even a animal would not have been left like that..They then went to great lengths to cover this all up at my expense. I won't give all the details but they are disturbing and would be to any medical professionals who cares about patients. No apology will be enough for the damage and pain I have to live with and my struggle to stay alive in that condition for 4 months before I was given IV antibiotics.It was very easy to take advantage of someone who has no ability to help themselves and a family that would be told NOTHING..All information and test results were intentional being withheld to deceive my family who were not around.. I was refused medical help after an ER doctor put false information in my medical records.My condition had been life threatening before and after the spinal tap.This left me in a critical condition without medical help and a hospital was refusing me care.I was left with abnormal gait, a latency of speech, photo-phobic,weak,with an inflamed body and brain,drowsy and in a state of hyperventilation.Even a animal would not have been left like that..They then went to great lengths to cover this all up at my expense. I won’t give all the details but they are disturbing and would be to any medical professionals who cares about patients.
No apology will be enough for the damage and pain I have to live with and my struggle to stay alive in that condition for 4 months before I was given IV antibiotics.It was very easy to take advantage of someone who has no ability to help themselves and a family that would be told NOTHING..All information and test results were intentional being withheld to deceive my family who were not around..

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121472 Anonymous Wed, 09 Dec 2009 21:08:53 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121472 Nuclear Fire:>>Oh, what medical school did you go to where they taught you that (assuming you meant fallible) because mine certainly didn’t?>>Actually, I attended veterinary school, where we learned to say "I'm sorry". From a purely selfish standpoint, it's served me well over the years - I can sleep at night.>>Could it be your singular bad personal experience is leading you to make a categorically insulting statement?>>Sure, but I don't know to which statement you are referring.Nicholas Fogelson:>>As long as I properly manage that complication and the patient was notified of the potential complications of surgery, this should not be negligence>>As you know, "negligence" and "complication" are not synonymous. Both can result in harm to the patient, though.>>That doesn’t mean I wouldn’t feel very bad that this problem happened to the patient. I would very much want to apologize that this happened, and even be able to clearly explain why it happened, if it was just because I made a technical error. It would be far better than just saying “these things happen it wasn’t my fault”.>>Actually, I think it is a choice NOT to apologize. What stops you from saying "I'm sorry"?Speaking as a patient now, not as a doctor (though I've been on the other side, and it's a humbling experience), I don't care how bad my former physician feels about the poor outcome. She probably does feel bad. Nuclear Fire:

>>Oh, what medical school did you go to where they taught you that (assuming you meant fallible) because mine certainly didn’t?>>

Actually, I attended veterinary school, where we learned to say “I’m sorry”. From a purely selfish standpoint, it’s served me well over the years – I can sleep at night.

>>Could it be your singular bad personal experience is leading you to make a categorically insulting statement?>>

Sure, but I don’t know to which statement you are referring.

Nicholas Fogelson:

>>As long as I properly manage that complication and the patient was notified of the potential complications of surgery, this should not be negligence>>

As you know, “negligence” and “complication” are not synonymous. Both can result in harm to the patient, though.

>>That doesn’t mean I wouldn’t feel very bad that this problem happened to the patient. I would very much want to apologize that this happened, and even be able to clearly explain why it happened, if it was just because I made a technical error. It would be far better than just saying “these things happen it wasn’t my fault”.>>

Actually, I think it is a choice NOT to apologize. What stops you from saying “I’m sorry”?

Speaking as a patient now, not as a doctor (though I’ve been on the other side, and it’s a humbling experience), I don’t care how bad my former physician feels about the poor outcome. She probably does feel bad.

]]> By: Millcreekhttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121441 Millcreek Wed, 09 Dec 2009 15:49:22 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121441 I am reposting my September 2009 comments to a similar thread. It is still relevant to this thread.MillCreek September 18, 2009 at 11:21 am I have worked in healthcare risk management and claims defense for almost 30 years now. I was advocating apologies long before any sort of shield law in my state. In my view, it is simply the right thing to do. Based on my anecdotal observation of hundreds of claims over the years, I don’t think that apology provides any sort of robust prophylaxis against litigation. It may prevent the occasional case from being filed, and it may soothe the anger on the part of the patient or family, such that a lesser amount of a settlement is accepted.If you really talk to the Michigan people, they will indeed agree that their apology/disclosure/settlement program is not in and of itself the sole reason for their reduction in claims expenses. It is in conjunction with other tort reform and loss control efforts. They can say with a straight face that the timing of the reduction in claims expenses coincided with the onset of their disclosure/settlement program, but it is more of a correlation than causation.I very much agree with the concepts of the SorryWorks people, and was using the same approach long before they came on the scene. I just do not buy into the belief that apologies will substantially reduce the number of malpractice claims. Probably the best way to determine if apologies start reducing claims in a significant way will be when the malpractice insurance company acturaries start reducing the premium in a meaningful way if you have an apology program. i have not yet seen any data from Tillinghast or Milliman suggesting that this is happening.7 MillCreek September 18, 2009 at 11:28 am I forgot to mention in my earlier comment that many of my defense legal and risk management colleagues are admanantly against apologizing because they feel it will increase litigation. Other than anecdoctal reports, I am unaware of any data that supports this contention.What does concern us is the difference between an apology and an admission of liability. I think apologies are peachy but discourage the admissions of liability unless I am involved in the process. Apologies rarely come back to bite you on the ankle, but admissions of liability sure can. I am reposting my September 2009 comments to a similar thread. It is still relevant to this thread.

MillCreek September 18, 2009 at 11:21 am
I have worked in healthcare risk management and claims defense for almost 30 years now. I was advocating apologies long before any sort of shield law in my state. In my view, it is simply the right thing to do. Based on my anecdotal observation of hundreds of claims over the years, I don’t think that apology provides any sort of robust prophylaxis against litigation. It may prevent the occasional case from being filed, and it may soothe the anger on the part of the patient or family, such that a lesser amount of a settlement is accepted.

If you really talk to the Michigan people, they will indeed agree that their apology/disclosure/settlement program is not in and of itself the sole reason for their reduction in claims expenses. It is in conjunction with other tort reform and loss control efforts. They can say with a straight face that the timing of the reduction in claims expenses coincided with the onset of their disclosure/settlement program, but it is more of a correlation than causation.

I very much agree with the concepts of the SorryWorks people, and was using the same approach long before they came on the scene. I just do not buy into the belief that apologies will substantially reduce the number of malpractice claims. Probably the best way to determine if apologies start reducing claims in a significant way will be when the malpractice insurance company acturaries start reducing the premium in a meaningful way if you have an apology program. i have not yet seen any data from Tillinghast or Milliman suggesting that this is happening.

7 MillCreek September 18, 2009 at 11:28 am
I forgot to mention in my earlier comment that many of my defense legal and risk management colleagues are admanantly against apologizing because they feel it will increase litigation. Other than anecdoctal reports, I am unaware of any data that supports this contention.

What does concern us is the difference between an apology and an admission of liability. I think apologies are peachy but discourage the admissions of liability unless I am involved in the process. Apologies rarely come back to bite you on the ankle, but admissions of liability sure can.

]]> By: Whttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121394 W Wed, 09 Dec 2009 11:57:02 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121394 There seems to be something in the whole culture of health care that resists accepting overt responsibility for mistakes. I can understand a doctor's reluctance to say "I'm sorry", but it often seems that any type of error one encounters -- billing snafu, misplaced chart, appointment mixup -- results in the patient being made to feel like it's somehow his/her fault. Have never heard apologies from administrative or support staff. What's preventing that? There seems to be something in the whole culture of health care that resists accepting overt responsibility for mistakes. I can understand a doctor’s reluctance to say “I’m sorry”, but it often seems that any type of error one encounters — billing snafu, misplaced chart, appointment mixup — results in the patient being made to feel like it’s somehow his/her fault. Have never heard apologies from administrative or support staff. What’s preventing that?

]]> By: Nicholas Fogelsonhttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121367 Nicholas Fogelson Wed, 09 Dec 2009 04:22:12 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121367 Its very important for physicians to be able to apologize for a mistake without that being used against them in a court of law. Physicians make mistakes from time to time, like every human being, but legally it takes more than a mistake to constitute negligence.If I accidentally injure the bowel during a hysterectomy surgery, I have made a technical error, but not necessarily done something negligent. As long as I properly manage that complication and the patient was notified of the potential complications of surgery, this should not be negligence.That doesn't mean I wouldn't feel very bad that this problem happened to the patient. I would very much want to apologize that this happened, and even be able to clearly explain why it happened, if it was just because I made a technical error. It would be far better than just saying "these things happen it wasn't my fault". Its very important for physicians to be able to apologize for a mistake without that being used against them in a court of law. Physicians make mistakes from time to time, like every human being, but legally it takes more than a mistake to constitute negligence.

If I accidentally injure the bowel during a hysterectomy surgery, I have made a technical error, but not necessarily done something negligent. As long as I properly manage that complication and the patient was notified of the potential complications of surgery, this should not be negligence.

That doesn’t mean I wouldn’t feel very bad that this problem happened to the patient. I would very much want to apologize that this happened, and even be able to clearly explain why it happened, if it was just because I made a technical error. It would be far better than just saying “these things happen it wasn’t my fault”.

]]> By: Nuclear Firehttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121353 Nuclear Fire Wed, 09 Dec 2009 00:14:19 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121353 @ Anon 1127: Oh, what medical school did you go to where they taught you that (assuming you meant fallible) because mine certainly didn't? Could it be your singular bad personal experience is leading you to make a categorically insulting statement? @ Anon 1127: Oh, what medical school did you go to where they taught you that (assuming you meant fallible) because mine certainly didn’t? Could it be your singular bad personal experience is leading you to make a categorically insulting statement?

]]> By: Rezmed09http://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121344 Rezmed09 Tue, 08 Dec 2009 20:57:43 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121344 Anybody who reviews charts knows that errors occur all the time. I would venture to say that there is some form of med error, hand off error, delay of diagnosis, feeding error, or complication in ~50% of hospitalizations. Many of these are potentially compensable, but most often not to degree that would make it economically worthwhile pursuing a tort claim. Maybe the solution is to have a follow up letter given to the patient and their attorney at the end of every hospitalization listing every "opportunity for improvement."In the meantime the polarization of our country on how we feel about our medical care, our expectation of perfection and our need for revenge will prevent any honest discussion. Anybody who reviews charts knows that errors occur all the time. I would venture to say that there is some form of med error, hand off error, delay of diagnosis, feeding error, or complication in ~50% of hospitalizations. Many of these are potentially compensable, but most often not to degree that would make it economically worthwhile pursuing a tort claim. Maybe the solution is to have a follow up letter given to the patient and their attorney at the end of every hospitalization listing every “opportunity for improvement.”

In the meantime the polarization of our country on how we feel about our medical care, our expectation of perfection and our need for revenge will prevent any honest discussion.

]]> By: David Harlowhttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121336 David Harlow Tue, 08 Dec 2009 18:28:46 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121336 The benefits of apologies are many. IHI has published on the reduction of medical errors in a provider organization whose culture includes the medical apology. Harvard and U of Michigan affiliates have found dramatic reduction in malpractice liabilities as a result of medical apologies policies. The psychic benefit to clinician and patient are beyond value. As part of my health care law and consulting practice, I provide training to boards and practitioners on the value of medical apologies and the implementation and tracking of appropriate policies and procedures. As they say, "Sorry Works." The benefits of apologies are many. IHI has published on the reduction of medical errors in a provider organization whose culture includes the medical apology. Harvard and U of Michigan affiliates have found dramatic reduction in malpractice liabilities as a result of medical apologies policies. The psychic benefit to clinician and patient are beyond value. As part of my health care law and consulting practice, I provide training to boards and practitioners on the value of medical apologies and the implementation and tracking of appropriate policies and procedures. As they say, “Sorry Works.”

]]> By: Evan Falchukhttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121333 Evan Falchuk Tue, 08 Dec 2009 18:04:09 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121333 Thanks for the link, Kevin.At least one of the commenters get the point of my post.Doctors should apologize if something goes wrong because it's the right thing to do.If there is some kind of malpractice, there will be plenty of evidence to show it. Doctors shouldn't have to think twice about acting like decent human beings because of fears of litigation.But the real pity is that we should need a law like the ones that have been passed in these 35 states.It shouldn't be necessary. Lawyers ought to be ashamed to raise such good, decent behavior as evidence of wrongdoing.Cheers,Evan Falchuk Thanks for the link, Kevin.

At least one of the commenters get the point of my post.

Doctors should apologize if something goes wrong because it’s the right thing to do.

If there is some kind of malpractice, there will be plenty of evidence to show it. Doctors shouldn’t have to think twice about acting like decent human beings because of fears of litigation.

But the real pity is that we should need a law like the ones that have been passed in these 35 states.

It shouldn’t be necessary. Lawyers ought to be ashamed to raise such good, decent behavior as evidence of wrongdoing.

Cheers,

Evan Falchuk

]]> By: twawhttp://www.kevinmd.com/blog/2009/12/doctors-patients-medical-errors.html#comment-121332 twaw Tue, 08 Dec 2009 17:55:30 +0000 http://www.kevinmd.com/blog/?p=41613#comment-121332 hmmm...when I was learning to drive (admittedly more than a few decades ago) I was given the same information in driver's ed. If you are in an accident, make sure everybody is ok, notify authorities, exchange information, and NEVER voluntarily admit fault (presumptively because of the land sharks). Have the rules of the road changed? hmmm…when I was learning to drive (admittedly more than a few decades ago) I was given the same information in driver’s ed. If you are in an accident, make sure everybody is ok, notify authorities, exchange information, and NEVER voluntarily admit fault (presumptively because of the land sharks). Have the rules of the road changed?

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