This seems to be the week for meetings about error, disclosure, and apology. I am currently at a very worthwhile seminar today at
Hebrew Senior Life (co-sponsored with BIDMC.) The lead-off speaker is
Dr. Tom Delbanco who reminded us that people who have been injured in the health care system often suffer from guilt, fear, and isolation. He noted that guilt, fear, and isolation are equally shared by the doctors and nurses who have been involved in medical errors. His point was that we need to bring down the walls that separate the two groups, and he offered strategies for doing that.
Tom noted that the anatomy of an apology is extraordinarily important. One person is in the mood to apologize and one is in the mood to be very upset. He created a scenario (based on someone crashing into someone else's car) and asked the audience to work in pairs, and take the two roles and spend a few minutes apologizing and receiving the apology. He then changed the scenario, and asked one person to be an injured post-surgical patient and the other the apologizing MD. Quickly, the buzz in the room changed as the one case, with lots of noise and laughing, transmogrified into the other, quieter and more serious.
"This is hard work. It's not easy. Most of you are not trained to do this," noted Tom. The same is true, he noted, for doctors. He talked about medical students he teaches, many of whom have seen an error in the course of their training, who say, "I don't have a clue how to deal with this."
What are the necessary steps in a proper and effective apology? Here's the summary. First, go over details openly and clearly with the patient about what happened. Second, display and feel real empathy, and say "I am really sorry." Third, tell the patient that a root cause analysis will be done, and that I'm going to find out what was the cause of the accident. Fourth, and most important, say what I am going to do about this so it won't happen in the future to another person. Research indicates that this last part is what patients really want.
He ended by charging the group with taking what they had learned today and trying to apply it in their practice of medicine. The talk was very well received by a diverse audience of care providers and lay people.
Tom noted that the anatomy of an apology is extraordinarily important. One person is in the mood to apologize and one is in the mood to be very upset. He created a scenario (based on someone crashing into someone else's car) and asked the audience to work in pairs, and take the two roles and spend a few minutes apologizing and receiving the apology. He then changed the scenario, and asked one person to be an injured post-surgical patient and the other the apologizing MD. Quickly, the buzz in the room changed as the one case, with lots of noise and laughing, transmogrified into the other, quieter and more serious.
"This is hard work. It's not easy. Most of you are not trained to do this," noted Tom. The same is true, he noted, for doctors. He talked about medical students he teaches, many of whom have seen an error in the course of their training, who say, "I don't have a clue how to deal with this."
What are the necessary steps in a proper and effective apology? Here's the summary. First, go over details openly and clearly with the patient about what happened. Second, display and feel real empathy, and say "I am really sorry." Third, tell the patient that a root cause analysis will be done, and that I'm going to find out what was the cause of the accident. Fourth, and most important, say what I am going to do about this so it won't happen in the future to another person. Research indicates that this last part is what patients really want.
He ended by charging the group with taking what they had learned today and trying to apply it in their practice of medicine. The talk was very well received by a diverse audience of care providers and lay people.