Part 2: Communicating Unanticipated Adverse Outcomes; How Do I Say I'm Sorry? June 15, 2015 Guest Blog, MIEC, Practice Management loss prevention, MIEC, physician communication 0 SFMS has partnered with the Medical Insurance Exchange of California (MIEC) to launch a two-part blog post series to assist physicians handle potentially difficult circumstances with compassion, truthfulness and candor. Click here to view part 1. SITUATION 2:Your patient says that your medical assistant was too rough as she changed his dressing. SUGGESTION 2: You say, “Gosh, Mr. Ali, I am so sorry it hurt. Although I know she’s usually as gentle as possible, I’ll ask her whether something happened that may have made her movements more abrupt this time. I hope she apologized as it happened. She did? Great, but I’m going to remind her, too, how important it is to keep you as comfortable as possible.” What can physicians do? Defense attorneys, professional liability carriers, risk managers, and physician consultants have long known why patients bring lawsuits against their physicians. First, those patients have been or believe they were injured. Second, they are angry. They are angry—about not having their questions answered, about being given too little information about their condition and treatment, because they were treated coldly or dismissively, and for other real or imagined slights during the course of treatment The first step a physician must take to ensure that he or she can successfully communicate about an untoward outcome is to establish a comfortable, solid rapport and trust with all patients from the outset of the doctor-patient relationship. To facilitate the best decision-making about whether or how to express sympathy, condolence, regret, or apology, the physician must anticipate and prepare for such an event. It is not possible to offer physicians specific advice for every possible circumstance and related contingency. Inevitably, there will be situations which require rapid judgment yet have far-reaching consequences. Every physician must consider the possibilities, be comfortable with the doctor-patient relationship, and rely on his or her moral compass for decision-making. In many situations, however, a framework of practical recommendations and a common sense application of them will cover most contingencies. Recommendations Anticipation and preparation—what to do BEFORE you are confronted with an unexpected adverse outcome: Establish and maintain a warm and communicative rapport with patients. Introduce new patients to you, your staff and your policies by giving them a “Patient Information Brochure” (Click here to contact MIEC Loss Prevention Department for sample brochures. http://www.miec.com/default.aspx?tabid=86&TabIdfrom=91). Ensure that your staff is well trained to welcome patients to your practice and convey interest in their well-being, both on the phone and in person. Hire staff who will convey warmth and reassurance to patients. Ensure that your staff knows how to respond to patient complaints to avoid escalation of perceived problems. Educate patients about their disease, condition, general health, medication, or other treatments. Give them written information about these topics and your advice. Tell them to read what you’ve given them and invite them to ask questions if they have any. Document that you’ve done so. Lay the groundwork for future discussions by having a thorough informed consent discussion prior to invasive procedures or other risk-inherent treatment. Remember that informed consent is a process, not a form. Obtaining informed consent is an opportunity to educate patients, answer patients’ questions, reassure patients, strengthen the doctor-patient relationship, and to realistically establish patients’ expectations. Thoroughly document your care, your justification for medical decisions, your patient education efforts, and your informed consent and informed refusal discussions. Contact your medical liability carrier’s Loss Prevention to participate in a physician-led communication training seminar to sharpen your skills in the art of disclosing of unanticipated outcomes, expressing compassion and empathy to patients and family members, and communicating in potentially difficult doctor-patient situations. Consider in advance, informally (with trusted colleagues) and formally (in appropriate committees or groups for that purpose), what you might do if faced with a situation in which a patient suffers an unexpected adverse outcome in which you played a role. These discussions needn’t involve actual cases that might be discoverable, but hypothetical circumstances of the kind physicians are likely to face. Include consideration in advance of what you might do if you were faced with such a situation and lacked the opportunity to call MIEC for advice about how to proceed. This article originally appeared in MIEC The Exchange, Issue 6 (April 2015). Click here for more information about MIEC and its service offerings. For more information about this article and loss prevention, please contact Dorothy Dukes, MIEC’s Senior Loss Prevention Representative at (800) 227-4527 or email dorothyd@miec.com. Comments are closed.
