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Mistakes Happen<
by: Bob Redling
What's the first thing you should do if a medical error harms a patient in your practice? No, it isn't calling your attorney. Instead, risk management experts say you should tend to your patient's needs while relying on your incident recovery plan to get you safely through the incident's aftermath. Don't have an incident recovery plan? Join the club. Risk management consultant Sarah Freyman Fontenot says many medical practices don't put enough thought into handling post-incident situations until they occur. They risk angering patients enough to cause them to lodge malpractice lawsuits, even when the bad outcome was not caused by a medical mistake. "The overwhelming evidence from studies going back a decade or more shows that full disclosure and talking to the patient and the family - being frank and prompt - all greatly reduce the incidence of claims against physicians," says Fontenot, a Houston-based nurse and attorney who teaches health law to physicians, nurses, and other health professionals. What evidence? A 1994 study by Howard Beckman, MD, and colleagues, for example, found that breakdowns in the physician-patient relationship - frequently miscommunication - were at the root of nearly three out of four malpractice legal actions filed against physicians. Beckman's study is one of dozens in the growing body of research into why some patients with bad outcomes sue their physicians for malpractice but others don't. In most cases, the physician's bedside manner seems to be the major contributing factor in soothing the anger of patients and their families. Adds Fontenot, "That doesn't mean physicians should run around giving mea culpa's every time anything goes wrong. It's very possible that they provided state-of-the-art medicine and the patient just didn't get the result expected." So, what should you do when things don't turn out as expected? Instead of clamming up or, perhaps just as hazardous, trying to improvise a response, you should develop an incident recovery plan and follow it. The plan should include making a full disclosure to the patient, debriefing staff and other physicians, documenting the incident, looking for process improvements, and making any required notifications. Full disclosure Telling patients and their families about a medical error - or an "unanticipated adverse outcome" as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) calls it - is how organizations meet their ethical and fiduciary responsibilities, says Sandy Reifsteck, a nurse and regional consultant for the Institute for Health Care Communication in Champaign, Ill. These errors can be caused by: * Unreasonable patient expectations. JCAHO standards go beyond reporting medical errors. The organization now calls for its accredited institutions to have full-disclosure policies in place and put them into action whenever there is an unexpected outcome, not just when an error occurs. Full disclosure to patients represents a distinct departure from the medical community's traditional approach to handling errors. Although full disclosure to a patient - and even apologizing if an error has occurred - may seem counterintuitive in today's litigation-frenzied world, that's what many attorneys, consultants, and physicians' malpractice insurance companies are advising doctors to do. "We're trying to correct a culture that for 40 or 50 years has told physicians to duck and cover when there's a problem and it's something that we won't turn around overnight," says Doug Wojcieszak, spokesperson for The Sorry Works! Coalition, an Illinois nonprofit that advocates for laws giving legal protection to physicians who voluntarily disclose errors to< |
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