Some patients who have been harmed during medical procedures are opting not to sue, but to talk with the medical team responsible for the harm. Health care professionals are being trained to apologize when things go wrong. Who benefits from a doctor’s mea culpa?
Listen to the full show:
Plus, in our web specials:Sit in on "disclosure training"for doctors, learn more about MITTS,and the three questions you should ask your doctorto help her avoid mistakes…
Radio Boston: Medical Errors
Airdate: February 1, 2008, 2008
- Guests:
Dr. Lucian Leape One of the leading experts on medical error, and professor at the Harvard School of Public Health
Andrew Meyer, One of the state’s leading malpractice lawyers and parter at Lubin & Meyer
Linda Kenney, President of Medically Induced Trauma Support Services
Paul Levy, CEO at Beth Israel Deaconess Medical Center, and author of the blog, Running a Hospital
Web Specials
Disclosure Training for Doctors
How should doctors talk with patients and their families after adverse medical events? How should doctors apologize when they make mistakes? Some local physicians have devised a program where hospitals would have “coaches” on staff to meet with medical teams immediately after adverse events to outline how to have difficult conversations with patients and their families. Radio Boston’s Kezia Simister sat in on a training session where Harvard University affiliated clinicians did some role playing about disclosing.
Listen as this “medical team” practices talking with a “patient and her husband” after she was given a dose of morphine ten times higher than needed:
Medically Induced Trauma Support Services
Linda Kenney started the organization in 1999 after her ankle replacement surgery turned into a much more grave event. Watch an excerpt from a video Kenney and her doctor telling their stories.
[youtube]http://www.youtube.com/watch?v=M8xq0HGoAfE[/youtube]
Go to the MITSSwebsite to request the dvd of the full MITSS story.
Curing the Culture of Medicine: Doctors reflect on medical errors and their profession
Written by Radio Boston’s Meghna Chakrabarti
In 1927, Harvard physician Francis W. Peabody wrote, "The secret to the care of the patient is in the caring for the patient."
This is the art of medicine. But is it the culture of medicine?
Following the 1999 report To Err is Human, and its finding that almost 98,000 Americans die each year from medical errors (a number that came out of the 1999 report), the health care industry could no longer avoid the old aphorism, "physician, heal thyself."
Put the patient first. Disclose errors immediately, honestly, and completely. That’s the prescription many in the profession have written for themselves. There’s intense resistance from many sectors, of course. But, it’s a remarkable idea. It’s like asking newspapers to emblazon their errors on the front page instead of burying them in a small corrections box deep inside the paper. You don’t see journalists clamoring to do that.
The three physicians (and one medical student) I met were passionate, committed, and determined to improve their profession. They had much more to say than I could fit in one report.
It’s worth listening to Dr. Jerome Groopmantalk about what patients can do to prevent misdiagnoses; medical student Deborah Vintondescribes the new way she’s being trained; Dr. Sigall Bellshares the emotional impact errors have on doctors and patients; and Dr. Allan Frankeltalks about the challenges medicine faces in moving to a culture of transparency.
Dr. Jerome Groopman
Chief of Experimental Medicine, Beth Israel Deaconess Medical Center, and author of How Doctors Think
Groopman is one of the most respected physicians in the Boston area. (He was a member of the medical team that treated the late King Hussein of Jordan.) A prolific writer as well, Groopman’s latest book is about what he calls the "thinking errors" that doctors routinely make in a health care system that forces them to rush.
As a result, almost 20% of patients are routinely misdiagnosed. "The most radical part of my book," Groopman says, "is the idea that patients have a critical role to play in avoiding errors."
He says every patient should ask their doctor three simple questions:
Q1: What’s past your first impression?
groop1.mp3
Q2: Are there pieces of the puzzle that don’t fit?
groop2.mp3
Q3: Can it be more than one thing?
groop3.mp3
Deborah Vinton
Third year medical student, Harvard Medical School
There’s been a revolution in medical education in the past decade. Students now routinely take "bedside manner" courses, medical law and ethics seminars, and communications classes. Harvard Medical School recently overhauledits curriculum. Now, students stay at one hospital, and follow a group of patients through their entire health care journey, rather than see patients only once as they rotate from hospital to hospital.
Students like Deborah Vinton are also a "different breed" of doctor, as one physician told me. They know they’ll probably make a medical error sometime in the future. Vinton says it’s a "virtual certainty." The focus in her medical education now is what to do when a mistake happens.
Dr. Sigall Bell
Infectious Disease Specialist, site director of Harvard’s "Patient-Doctor 3" course, Beth Israel Deaconess Medical Center
"To err is human," yes, but also, "to forgive, divine." Dr. Sigall Bell and her colleague, Dr. Thomas Delbanco investigated that second half of the equation. Dr. Bell wants to understand why the human dimensions of the issue hadn’t been better discussed among physicians.
The findings, published in a paper Guilty, Afraid and Alone - Struggling with Medical Error, were surpising:
She brings these lessons to medical students in Harvard’s "patient-doctor" course. What to do when there’s an error? Bell describes a novel program being piloted at many hospitals: a team of "first responders" or "coaches" who are on-call to attend to the immediate emotional needs of patients and doctors in the chaotic wake of a medical mistake.
Dr. Allan Frankel
Institute for Healthcare Improvement
Dr. Frankel has practiced anesthesiology for a quarter century. He was asked to lead a patient safety team at Newton-Wellesely Hospital in 1995, following a series of maternal deaths. Frankel became one of the leading experts in patient safety, serving as director of patient safety for Partners HealthCare System, and as a board member for the Massachusetts Coalition for the Prevention of Medical Errors.
Frankel looks at the totality of the health care system, everything from lab errors to medical malpractice. Patient safety has everything to do with physician attitude, he says. One of the challenges doctors face, he says, is changing the expectations they have for the historic autonomy in their own profession:
But doctors aren’t working in isolation. They’re part of an enormous health care system that’s very risk averse, he says. Frankel believes that the "culture of the health care industry" deserves equal scrutiny:
Making patients safe means examining the entire health care system, Frankel says. He believes, like many in the patient safety world, that health care needs to adopt techniques used in engineering and aviation: look at the entire system design, identify failures when they happen, be transparent about those failures, collect data, collaborate on solutions, encourage innovation rather than discouraging discussion when there’s a problem, offer liability protection to hospitals that are aggressive about patient safety.
A very daunting task, Frankel admits. But, he says, medicine doesn’t have a choice:
Now that the ground has thawed let’s go on an archaeological dig. What are some of the latest big local discoveries? What do historical artifacts teach us about our past?
An Email from Boston:
—-
Hi - My mother has been a nurse for over 45 years at a very prominent
hospital in Chicago in Open Heart Surgery. My mother used to say all
the time “doctors tend to be very arrogant and self-absorbed thinking
they’re incapable of making mistakes.”
One day my mother watched a doctor give too much medication to one of
her patience. She warned the doctor that he was making a mistake but
he went ahead anyway telling my mother “I am the doctor here,
nurse.” When the patient had an adverse reaction, the doctor tried
to blame my mother saying she administered the medication. Clearly
my mother was not having any of this and put the full responsibility
back on the doctor.
My mother always said “doctors need to realize they’re first and
foremost a human being treating another human being. Doctors can
make mistakes but they need to realize, admit it, and take
responsibility for it.”
- Chokdee Rutirasiri
Boston, MA
Dara Emailed us with this comment:
Apparently there are a lots of mistakes.
May be it is better to have the hospital screen the affiliated Doctors annualy rather than Board Certificates. Then hospital can cover the liability insurance for them and in return receive a percentage of their revenue for insurance coverage.
Dara
We received this email from Watertown:
———————
I have been ill for over 23 years with multiple diseases, surgeries, admissions.etc. I broke my wrist in January 07 and it was cast by a physician’s asst in an orthopod practice. I repeatedly told her that it hurt (when returning weekly for x-rays), the x-ray technician even said after my reaction to her necessary manipulation that it should not hurt like that and she would tell the phys asst. Each time the latter brushed me off and said it was “appropriate” for the break. I then was admitted to the hospital for something else and during tne admission, x-rays were taken of my arm while getting the regular abdominal/chest series. I was woken in the middle of one night and told that I needed “emergency surgery to save my arm”. However I had an infection w/temp of 104 degrees due to a catheter (access purposes) Three days of major antibiotics and a lot of people scurrying w/nervous faces; At this point in my medical life any surgery is life threatening (common knowledge among my medical team) but I had to have this surgery on my wrist (w/only iv access for surgery in my baby toe!) physical therapy, a site infection and a year later my wrist and arm are still not the same.
My objection has always been that the person who cast my arm was well aware that I was a High Risk Patient, both from my massive file and a long conversation while she cast me, and yet she did not
HEAR me, did not RESPECT my experience and knowledge of MY BODY. I wrote a letter to the three surgeons who head the orthopod practice this past summer (having never met any of them, I felt I
at least needed to tell them what happened in their office ( at the suggestion of my extremely upset gastroenterologist) and NEVER heard any response from these three men. Again, they did not HEAR or RESPECT the experience of a high risk patient. That is so very offensive to someone who has been through as much medically as myself; and sadly that happens constantly to people everywhere, everyday when dealing with people who think they are on a higher level than we mere mortals.
I thought about contacting a lawyer, if only to make people see how important RESPECT is to the patient; my doctor of 23 years told my family that he was literally “embarrassed by the entire medical profession” but worries that I would not survive a malpractice trial, and also, in all probability a jury might very well hear of my health history and decide that the problem was not the improper casting and 5 weeks of my wrist being in wrong position, but rather a result of my challenged immune system and poor healing ability.
A year late I still have problems with my wrist, and it visibly is not right(while standing in a cashier’s line,I actually had a woman say that she was happy that my suicide attempt had not worked as she stared at my arm/ Unbelievable! But Mainly, as my regular lifelong medical problems and admissions continue, I find I have lost so much trust for people I have known forever, and I am Still So Ticked Off that a physician’s assistant female of approx 25 yrs old caused this situation because she was too “busy” to HEAR me, too full of herself perhaps to ACKNOWLEDGE my substantial medical experience; my wrist could have been recast properly by the second week if she”d only LISTENED.
The broadcast is now over but regardless, I am sending this mail in case someone is there to read the stories responding to your show. Perhaps someone might have a suggestion as to the course I should take, but primarily I want Someone to LISTEN, if you know what I mean!
Thank you,
Deborah Hosmer Grudzinski
Watertown, Mass.