| Sandy 2004-11-14, 11:09 am |
| The Associated Press
Updated: 3:04 p.m. ET Nov. 11, 2004CHICAGO - It's a lesson children
learn even before their ABCs — say you're sorry when you hurt someone.
But it's now being taught in the grown-up world of medicine as a
surprisingly powerful way to soothe patients and head off malpractice
lawsuits.
Some malpractice-reform advocates say an apology can help doctors
avoid getting sued, especially when combined with an upfront
settlement offer.
The idea defies a long tradition in which doctors cultivated a Godlike
image of infallibility and rarely owned up to their mistakes.
The softer approach, now appearing in some medical school courses and
hospital policies, is drawing interest as national attention has
turned to reducing both medical errors and the high cost of
malpractice insurance, which has been blamed for driving doctors out
of business.
A relationship sea change
Doctors' often-paternalistic relationship with patients is giving way
to an understanding that "it's OK to tell the patient the whole
story," said Dr. Paul Barach, an anesthesiologist and patient safety
researcher at the university of Miami. It is "a huge sea change as far
as our relationships with patients."
‘You don't want them to be Godlike. They have to be willing to step up
to the plate and say, 'I made a mistake.'
— Bob Vogt
Retired Cadillac dealer
The hospitals in the university of Michigan Health System have been
encouraging doctors since 2002 to apologize for mistakes. The system's
annual attorney fees have since dropped from $3 million to $1 million,
and malpractice lawsuits and notices of intent to sue have fallen from
262 filed in 2001 to about 130 per year, said Rick Boothman, a former
trial attorney who launched the practice there.
Bob Vogt, a retired Cadillac dealership employee from Belleville, said
an apology might not have stopped him from suing over the misdiagnosis
of a brain aneurysm in 1990 that he contends left his wife severely
disabled. But it might have saved his relationship with the doctor,
once a close friend, he said.
"If he had come forward and not tried to conceal the thing, I probably
would have had a lot better feeling," Vogt said. "You don't want them
to be Godlike. They have to be willing to step up to the plate and
say, 'I made a mistake."'
Dr. Michael Woods, a Colorado surgeon and author of "Healing Words:
The Power of Apology in Medicine," said his own experience a decade
ago illustrates the impact of the traditional way doctors have handled
mistakes.
Woods was overseeing surgery to remove a patient's appendix. A medical
resident accidentally punctured an artery, which led to a more
extensive operation. The patient was unhappy with how Woods handled
the aftermath; during one visit, Woods propped his feet up on the desk
and, in her opinion, acted as if he didn't care.
Woods said he wanted to apologize, but legal advisers recommended
breaking off contact with the patient when she threatened to sue.
Say-you're-sorry-movement
Now a consultant to doctors and the malpractice insurance industry,
Woods said his research has shown that being upset with a doctor's
behavior often plays a bigger role than the error itself in patients'
decisions to sue.
The say-you're-sorry movement has been prompted in part by emerging
evidence about the scope of medical errors. An Institute of Medicine
report in 1999 said mistakes kill as many as 98,000 hospitalized
Americans each year.
Supporters of the strategy want the Illinois Legislature to adopt a
program called "Sorry Works" that recommends apologies and settlements
when mistakes occur. Under the proposed pilot program, two Illinois
hospitals would be recruited to see if the policy saves money.
While the number of settlements would probably increase, lawsuits and
sky-high jury awards would decrease, said Doug Wojcieszak, a public
relations consultant whose victims' rights group proposed "Sorry
Works."
Apologies and upfront financial offers could mean the difference
between settlements costing thousands of dollars and drawn-out
malpractice lawsuits costing millions in attorney fees and jury
awards, Wojcieszak said.
The idea for "Sorry Works" came from an honesty policy the Veterans
Affairs hospital in Lexington, Ky., adopted in 1987 after two big
malpractice cases cost the hospital over $1.5 million.
Dr. Steve Kraman, then the hospital's chief of staff, said he helped
create the policy as an alternative to the traditional "shut up and
fight" strategy. The center's liability costs subsequently dropped
below those of comparable VA hospitals, he said.
"Not only was it the right thing to do, but over the long haul, we
were saving money by doing things this way," he said.
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