Open and transparent

hands by Shutr
Doctors Say ‘I’m Sorry’ Before ‘See You in Court’ :
[Via New York Times]

In 40 years as a highly regarded cancer surgeon, Dr. Tapas K. Das Gupta had never made a mistake like this.

As with any doctor, there had been occasional errors in diagnosis or judgment. But never, he said, had he opened up a patient and removed the wrong sliver of tissue, in this case a segment of the eighth rib instead of the ninth.

Once an X-ray provided proof in black and white, Dr. Das Gupta, the 74-year-old chairman of surgical oncology at the University of Illinois Medical Center at Chicago, did something that normally would make hospital lawyers cringe: he acknowledged his mistake to his patient’s face, and told her he was deeply sorry.

Think about what might happen if the lawyers took a lower profile and the doctors admitted their mistakes, if they were open with their patients. Turns out, something significant happens. Most people accept the apology and forgive the doctor.

This approach directly contradicts what most lawyers advise.

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.

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

People get really angry when they find out the error was concealed and that it might happen again. As with political scandals, it is the coverup that causes the problems.

So what happens if the doctors and hospitals are open with their patients?

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.

From 262 to 83 in 6 years. Defense costs down by two-thirds. Malpractice cut in half. These are game changing numbers, in the completely opposite direction from what lawyers said would happen.

The hospitals have also taken to following up the apology with fair compensation. This has had the effect of changing the behavior of malpractice attorneys.

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.

In all likelihood, more money ends up in the patient’s pocket and less in lawyer fees. As long as the awards are also open, so that the hospitals can not manipulate the settlements too much, and people can really see that they are not committing the same errors again and again, the beneficial cycle of this should not only drive malpractice suits lower but also help care in the hospitals.

Quality improvement committees openly examine cases that once would have vanished into sealed courthouse files. Errors become teaching opportunities rather than badges of shame.

“I think this is the key to patient safety in the country,” Dr. McDonald said. “If you do this with a transparent point of view, you’re more likely to figure out what’s wrong and put processes in place to improve it.”

For instance, he said, a sponge left inside an patient led the hospital to start X-raying patients during and after surgery. Eight objects have been found, one of them an electrode that dislodged from a baby’s scalp during a Caesarian section in 2006.

This looks like a program that could have huge effects across the country. By admitting their errors and treating the patients like rational human beings, the doctors remove themselves from antagonistic relationships, the hospitals spend less money on lawsuits and the standard of care goes up.

All by showing a little openness and transparency.

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