Owning up to mistakes: Regaining a sense of professionalism
To err is human. Unfortunately, in our medical system, we expect that physicians are superhuman and therefore choose not to build the support and error reduction measures that would allow mere humans to competently practice high quality health care.
Having not built the systems to reduce errors, our hospitals and medico-legal system have decided that in addition, denying that errors happen is the best way to make them go away. In stark contrast to the principles of six-sigma, lean manufacuring, and other systems to reduce errors, the
medical system decided that it would instead announce the superhuman perfection of its approaches and allow those who thought otherwise to take them to court.
Per a recent article in the NYTimes:
For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.
However, by taking back the mantle of professionalism and owning up to their own mistakes, doctors (and hospitals) are seeing benefits to defying conventional lawyer-driven wisdom.
By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.
Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.
Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible.
At the University of Michigan Health System, one of the first to experiment with full disclosure, existing claims and lawsuits dropped to 83 in August 2007 from 262 in August 2001, said Richard C. Boothman, the medical center’s chief risk officer.
“Improving patient safety and patient communication is more likely to cure the malpractice crisis than defensiveness and denial,” Mr. Boothman said.
There are important lessons here:
1) Medicine is first a profession, who’s roots are anchored in a trust that patients have in their doctor’s ability to look after them. Violations of that trust yield a sense of violation and emotional need for retribution that go far beyond what simple mistakes would otherwise require to address or fix. Owning up to mistakes and highlighting how they are being fixed instead restores the professional nature of the conversation and, while not a terrific conversation, allows that doctor to regain trust in working toward a solution.
2) Without transparency, these problems don’t get fixed. To follow the legal line of thinking, any investigation of systematic error must be suppressed to ensure that the trials don’t uncover institutional awareness of the problem being denied. Instead, we must make sunlight our disinfectant– understanding outcome metrics and where we are falling short will allow our best and brightest minds to develop solutions. The choice of metrics is important– we will only manage what we measure.
3) The time and tools for effective communication need to be in place. The hamster wheel of current medical practice trains physicians to be technicians rather than trusted advisors and thought partners. Ensuring that physicians have the time to build trust and help guide patients through their options is critical for those patients to then feel engaged and empowered. Few people will lash out at that experience, even when bad things happen– per a presentation by Dr. Thomas LaGrelius of SIMPD, concierge medicine docs haven’t yet been sued for malpractice. Maybe, if we spend time with our patients and are responsive, they realize that their doc has done everything humanly possible.
4) Doctors are not superhuman and we need to stop expecting that level of performance. We need to build the right systems and support mechanisms to amplify the capabilities of the talented people in whom we trust our lives. We also need our medical schools to change the focus from the merely technical and clinical into helping raise a generation of physicians that can be true quarterbacks and leaders of teams to best help their patients reach their health goals.
