Tuesday, May 20, 2008

Doctors Learn to Say “I'm Sorry”

X-ray of an electrode left inside a patient during a C-Section.
Photo: University of Illinois Medical Center. Published in The New York Times, May 18, 2008.

Transparency From Doctors Results in Less Lawsuits
Better Overall Results

Gee Gidge, you think?

Transparency damn near always works.

Hospitals which expose their mistakes to patients, are discovering their malpractice costs drop dramatically.

The New York Times

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.

Mr. Boothman emphasized that he could not know whether the decline was due to disclosure or safer medicine, or both. But the hospital’s legal defense costs and the money it must set aside to pay claims have each been cut by two-thirds, he said. The time taken to dispose of cases has been halved.

The number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago, said Dr. Timothy B. McDonald, the hospital’s chief safety and risk officer. In the 37 cases where the hospital acknowledged a preventable error and apologized, only one patient has filed suit. Only six settlements have exceeded the hospital’s medical and related expenses.

I had a major malpractice lawsuit against a physician once.

The outcome is sealed, as is often the case. According to the terms, I'm forbidden to talk about how it turned out.

I will say, a large part of what drove the case, is how ANGRY I was at what I saw as brutal malpractice on the doctor's part. A genuine apology... I don't know what it would have done. I'm someone who believes in authentic apologies. At the same time, I had (and still have) permanent long-term damage, so I probably would have felt some compensation was appropriate.

But that's the point. When a mistake is made, admit it, clean up the mess, and move on. When there isn't a legitimate mess, fight it with everything you have.
The New York Times

There also has been an attitudinal shift among plaintiff’s lawyers who recognize that injured clients benefit when they are compensated quickly, even if for less. That is particularly true now that most states have placed limits on non-economic damages.

In Michigan, trial lawyers have come to understand that Mr. Boothman will offer prompt and fair compensation for real negligence but will give no quarter in defending doctors when the hospital believes that the care was appropriate.

“The filing of a lawsuit at the University of Michigan is now the last option, whereas with other hospitals it tends to be the first and only option,” said Norman D. Tucker, a trial lawyer in Southfield, Mich. “We might give cases a second look before filing because if it’s not going to settle quickly, tighten up your cinch. It’s probably going to be a long ride.”
If you know that you'll be fairly compensated for genuine negligence, the adversarial relationship begins to shift between the trial bar and hospital staff.

Transparency -- telling the truth -- benefits everyone. Financially, in terms of time it takes to reach a settlement, in putting systems in place to correct problems, and emotionally both to the medical staff and the patients.

Medical staff from Day One of their training are raised with “First do no harm.” Transparency allows them to tell the truth about what happened, fix the problem, and know that their patients get treated fairly. And the medical staff know that patient outcomes benefit, while they are not held to blame for honest mistakes.

Patients know that in a system built around transparency, if something does go wrong, there is an institutional commitment to telling the truth, and making certain they as patients find out what happened, while simultaneously fixing the underlying problem in the system. And as patients they know, they will be fairly compensated for any damage.

All that is needed is trust, and a commitment to tell the truth.

Transparency is good for everyone.