Question from Medical Student: OK to Cry?

crying docI recently gave a Sorry Works! presentation to a group of medical students. I love teaching medical students…they’re not jaded and it’s cool to think about where they will scatter — with the disclosure message — in four years or less.  So, during Q&A one of the students posed the following question (and statement):

“Is it OK to cry with a patient or family?  Is it acceptable to show emotion?  I have heard historically in medicine that doctors (and nurses) were not allowed to display emotions, and as a student today I still get the feeling we should keep our distance from families and put on a brave face no matter what.”

My response: I love it when healthcare professionals show emotion, but I am scared when a doctor gives a robotic response to an overwhelming tragedy.  I want to be treated by a crier/hugger as opposed to a robot who appears not to give a damn.  Physicians need to be able to treat the whole person, and our emotions and mental health are as important as any organ or blood vessel.

This question reminded of another question/statement from a resident.  This young doctor had a little girl die on his watch…he did all he could medically with the parents crying their eyes out in the corner, but when the child was finally declared dead the doctor quickly left the room “because he had other patients who needed him.”  The resident asked what I thought of his behavior.  I gently responded: “Your next patient could have waited five or 10 minutes while you comforted the parents….we wait all the time for you guys, what’s another 10 minutes when you are dealing with a dead child?  And when you finally got to the next patient simply apologize for being late and explain you were comforting grieving parents, and that next patient will completely understand.”

The resident thought about my response, then asked another question: “Every day when I drive home I travel past a Hallmark store, and I’ve thought about getting a sympathy card for the parents, but I’ve never done it, and now we are six weeks past the death, am I too late?”   My response: “Six weeks is the point in the grieving process when the flowers have died, the sympathy cards have stopped coming, and co-workers and neighbors want grieving people to ‘act normal’ again…but they can’t!   So, you sending a card with a simple message and perhaps including your business card welcoming a phone call might help those parents get through their day.”

And this all leads up to the ultimate classic question/statement: “Is it a good idea to attend a patient’s funeral?   We’ve been told by some folks not to attend a patient’s funeral.”  Answer: Yes, attend funerals or wakes, because it shows you care, and isn’t that what medicine is supposed to be all about?!   Caring!

A great way to expose medical and nursing students as well as veteran clinicians to disclosure is with the Disclosure Documentary produced by Lawrence and Steve Kraman. The film is a terrific teaching tool — available in a Grand Rounds version or a longer 1.5 hour version — that will get students and staff talking and thinking about disclosure. To preview the film, e-mail Please include 1. the name of the organization, 2. your title/role and 3. Your e-mail address. There is no obligation to purchase.

I hope this column is shared with medical and nursing students and residents, and also veteran clinicians.    Have a great day.

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Disclosure, Apology Finally Coming to Military Medicine?

dodEarlier this year, we wrote an e-newsletter/blog sharply criticizing the lack of disclosure, apology and transparency in military medicine, and challenging the Obama administration in its closing months to order changes. Our column was inspired by a lengthy New York Times article which detailed the anger experienced by military families left in the dark after medical errors — and the lame excuses offered by military leaders why the troops couldn’t know the truth.

Well, maybe disclosure and apology is finally coming to military medicine.

According to a recent Military Times article, the Department of Defense has created and is apparently expanding a program called “Healthcare Resolutions.” The program appears to have many similarities with traditional disclosure programs, including the fact that patients/families do not lose the right to file a claim or lawsuit (if they feel the need to do so), and consumers can be represented by counsel. However, it appears the Healthcare Resolutions specialists/leaders make no determination if an error occurred (or not), and they will disengage from a case if a lawsuit is filed. For an apology to be genuine and be real to all stakeholders — including clinicians — a credible review to determine if a mistake happened must be part of the disclosure process. And just because a lawsuit is filed, folks shouldn’t leave the playing field. Perhaps tweaks need to be made to this new Healthcare Resolutions program?

Nevertheless, the development of the Healthcare Resolutions program may be welcome news. We encourage the military to share more information about the program, and hopefully the program will be refined and expanded. Over the years, Sorry Works! has had the pleasure of working with many military healthcare professionals who want disclosure for soldiers and families, so we will keep our fingers crossed.

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Cameras in the Operating Room? The Discussion Continues…

In response to recently introduced Wisconsin legislation, we penned a column this past video camerasummer about the use of cameras in the operating room or so-called “surgical black boxes.” We got a lot of feedback from healthcare, insurance, and legal professionals, and almost all of it good and supportive. One veteran risk manager wrote, “How do we fix problems if we don’t know what they are?” And several lawyers wrote the evidence is powerful, and usually FOR the doctors and nurses. Unfortunately, these folks don’t work for the hospital and medical lobbying groups. The Wisconsin hospital and medical associations — the state where this legislative proposal has first been proposed — think it’s a terrible idea that will “get in the way of the patient/doctor relationship.”


How does me the patient or the family knowing what is happening in the operating room get in the way of a relationship with my doctor? Anyone who understands or has experienced marriage counseling knows that secrets in a relationship are a ticket to trouble. Being open is the best policy with those you want to trust. Why do medical and hospital lobbyists think they are different? Nope, just more knee jerk reactions and fears that this idea will benefit the evil trial lawyers. This crowd said the same things about disclosure 10 years ago…..

Moreover, when you think about it, operating rooms are full of technology, computers, and other gadgets which if coaxed by a qualified technician can spill all of their secrets. Also, today’s patients and families come armed with smart phones that record every utterance and image— remember the surgical case from the summer? Indeed, we already have many “mini” black boxes in operating rooms as well as waiting rooms and everywhere else in the hospital or doctor’s office, so why not the full Monty?

Lastly, most hospitals claim they are supportive of disclosure (although the truth is the “support” comes in various shades and colors). So, if we all like disclosure, then let’s really be transparent! Videotape the operations, and, as many defense lawyers say, the tapes will usually show the complainant there really is no case. When, however, the tape shows a mistake, no worries, we were going to disclose anyway! Now we can show you the screw up in color on our I-PAD.

With this last point in mind, I think true disclosure hospitals will have to lead the way on this idea. It may too big a push legislatively, but a disclosure hospital can say (without legislative approval) to their surgeons, “Look, you know our disclosure policy, if you make a mistake we want to know about it, together we will go to the family, and together we will get everyone right, including you. So, the camera is just another tool to help us that do that.” When these disclosure hospitals start reporting their experiences using cameras and can show the roof didn’t fall in, well, then, the idea will get a lot less scary, including for the medical lobbyists.

Remember Sorry Works! is marketing the Disclosure Documentary developed and produced by Lawrence and Steve Kraman. This movie provides audiences with an in-depth look at disclosure from all stakeholders — including detractors! — and it is wonderful for Grand Rounds, staff retreats, medical and nursing students, and other audiences. The documentary helps healthcare professionals understand this very important issue. To order your copy, click here. Officials considering the purchase of this film for their organization can view the complete film in advance by sending an e-mail to Please include 1. the name of the organization, 2. your title/role and 3. Your e-mail address. There is no obligation to purchase.

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Hospital Continues to Send Mail to Grieving Family – Then Apologizes!

wadeOn several occasions Sorry Works! has shared the story of Wade and Jennifer who lost their daughter to medical errors at Children’s Hospital Oakland (CHO) – now named UCSF Benioff Children’s Hospital Oakland after a recent merger. We even shared the Westhoff’s experience in the new Sorry Works! Tool Kit Book. There are many angles to this tragic story, but one facet is painfully simple and incredibly galling: This hospital continued to send mail to the Westhoff family! Despite in-person pleas from the family, media coverage, and a mutual understanding when the case was settled, the family continued to be assaulted at the mail box.

The latest piece hit recently….it was one of those “read about our latest miracle and send money!” solicitations that hospitals routinely use. Wade said it was another punch in the gut. Part of Wade would like to re-write the fundraising pitch: “Read about how our daughter died at this hospital due to medical errors and the hospital treated us horribly afterwards…including repeatedly sending mail to us. Don’t send money to this hospital!”

Wade also confided to me that he simply thought about throwing the letter in the recycling bin and forgetting about it. His family will be moving shortly, so CHO’s mail will come to a complete stop eventually due to the move. However, Wade feels a duty to his daughter and other families to share what is happening. Perhaps CHO will never change — even after local media in the Bay area reported this problem – but perhaps other hospitals will learn from CHO’s continued insensitivity.

On a chance, Wade wrote the attorney who represented the hospital during his daughter’s lawsuit. Wade laid it out in an e-mail just like it is presented here…and the attorney let the hospital know! To their credit, the hospital contacted Wade, scheduled a conference call with Wade and several hospital executives, said they were “mortified,” apologized several times, and promised to never let it happen again. The conference call was not without pitfalls…one CHO/UCSF executive who had a sick child said she “understood” Wade’s feelings. Wade quickly rebutted: “So, did your child die due to preventable errors?” The hospital executive quickly retreated. The call ended with a CHO/UCSF executive confiding to Wade that his daughter’s case identified several problems and shortcomings in the hospital, and they are working to improve in these areas. We can certainly hope. In looking back at the conference call, Wade and his family felt this was the first time that CHO/UCSF actually heard them and actually “got it” as far as the need to improve their communications program. For the first time since his daughter’s death, Wade feels some optimism about the ability of CHO/UCSF to improve their care and communications efforts with families.

Earlier this year, I was conducting a Sorry Works! training for a large hospital system, and I shared the Westhoff’s story as part of the seminar. When I finished describing the Westhoff’s experience, the hospital’s General Counsel raised her hand and I called on her, but instead of addressing me she turned instead to the hospital marketing chief and stated, “Don’t let this happen at our hospital. We cannot do this to our patients and families.” I shared this experience with Wade and it made him feel good…his family’s story is already making a difference.

Moral of the story: Patients and families need communication from hospitals, practices, and clinicians post-event, but that communication must be empathetic and delivered in an intelligent fashion. Bills, marketing magazines, surveys, and fundraising solicitations are insensitive and cruel to any family, and make the hospital/practice look stupid and incompetent. Moreover, people should not have to move away to stop the assault at the mail box. With a few key strokes, good disclosure hospitals can suspend all mail, including bills, marketing magazines, surveys, fundraising letters, etc, to families who have experienced adverse medical events. All communication attempts need to go through the disclosure team and clinicians involved in the event – period.

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Another British Hospital Apologizes for Baby’s Death

In late September we reported that a British Hospital apologized and admitted liability for mistakes that led to the death of a baby. We also reported in October that an American hospital (State of Idaho) had apologized for medication errors that caused the death of an infant. Well, it was reported yesterday that another British Hospital — lghLeicester General Hospital — apologized and admitted liability in the death of a baby. Baby Delilah Hubbard died two days after birth, the victim of medical malpractice. In their admission of liability, the hospital said staff did not treat the high risks pregnancy in an appropriate manner and was slow to order a C-section, among other items.

The news article included the statement of apology from the hospital — no weasel words here:

In a statement, Joan Morrissey, Midwifery Matron at Leicester’s Hospitals said: ‘In light of the mistakes that were made in the way Delilah’s birth was managed we know that an apology can never undo what happened and may bring little comfort to Mr Hubbard and Ms Bassford. Nevertheless we are deeply sorry for the mistakes that were made and we would like to send our condolences to them both. We let them, and Delilah down. We have written to Mr Hubbard and Ms Bassford offering our sincerest apologies for what happened and to provide them with a copy of the detailed investigation report we carried out following Delilah’s death. Senior members of staff also met with Mr Hubbard and Ms Bassford to discuss their concerns and talk them through the findings of our investigation.” We have taken this tragedy incredibly seriously and will be attending the inquest in April to explain to the Coroner exactly what went wrong and what we have done and will be doing to ensure as far as possible that this does not happen again.’

This appears to be a powerful example of apology and how healthcare organizations can use disclosure to learn from events and provide closure for all stakeholders. Moreover, it is good to see hospitals publicly owning mistakes in potentially high value cases, as opposed to seemingly low value cases as we have discussed in this forum recently.

Disclosure starts with teaching your directors, managers, and front-line staff how to say “sorry.” The Little Book of Empathy is a terrific teaching tool for healthcare, insurance, and legal professionals. We’ve sold thousands of copies….to receive your copy, click here.

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How to Preview the Disclosure Documentary

flyerOver the last month, we’ve told you all about the new Disclosure Documentary produced by Lawrence and Steve Kraman, and marketed by Sorry Works! A lot of buzz has been generated, and many people are interested in purchasing the film for their organization.

Officials considering the purchase of this film for their organization can view the complete film in advance by sending an e-mail to Please include 1. the name of the organization, 2. your title/role and 3. Your e-mail address. There is no obligation to purchase.

*The $500 price is for one hospital, group practice, or nursing home…..organizations with multiple hospitals or multiple nursing homes or multiple insureds (such as a PIAA carrier) or organizations with multiple members should call 618-559-8168 or e-mail for a quote. The license agreement for the film is as follows: Upon payment of the sum of five hundred dollars ($500.00), Newport Classic hereby grants to Licensee the non-exclusive right, for the life of the relevant DVD copy, to: (a) include the Film in Licensee’s public library to its authorized users and/or card-holders for the purposes of research, education, or other non-commercial or non-performance use for student, staff and faculty or any additional authorized users; and/or (b) exhibit the Film in a public or private setting, provided that such screening is in a non-theatrical and non-broadcast setting. The Film may not be exhibited to an admission-paying audience.

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Hospital Shares Errors, Apologies with the Public

bwhRecently, I was alerted by a reporter that Brigham and Women’s Hospital in Boston is now sharing stories of errors and apologies with the public. The hospital is publishing stories and posting them on the Internet for the whole world to see.

We applaud this move. For years at Sorry Works, we have told hospitals, long-term care facilities, and the insurance, claims, and legal professionals who serve them that disclosure should NOT be contained within the four walls of their buildings. We routinely instruct people to share the details of their disclosure programs with the public, the media, and the trial bar, and, when appropriate, share stories of specific cases. We need to educate the public and — moreover — CHANGE the public’s perception that doctors and nurses will run away post-event and the only way to get answers is to file a lawsuit, file a complaint with the state or the media, rant on social media, etc. Following an event, consumers need to know they can go back to their hospital/doctor with questions and will be treated fairly . Trial lawyers also need to know the door is open and phone calls/e-mails are welcomed.

The two disclosure stories shared so far by Brigham and Women’s Hospital involved a delayed diagnosis of cancer in an 85-year old woman (which was viewed not to have impacted her chances of survival), and a mistake in an infant leading to a scar on the wrist (which was viewed not to warrant plastic surgery). It will be interesting to see if Brigham and Women’s — and other hospitals — will begin publishing disclosure/apology stories of truly compensable errors. There is still an unwarranted fear among some claims and legal professionals that by telling the public the hospital or nursing home paid money on a case that the flood gates will open, families and their lawyers will be lined up around the corner looking for handouts, etc. The claims record of the University of Illinois Medical Center (in Cook County!), University of Michigan Health System, and other systems who have been public about compensable errors do NOT validate these fears. In fact, the public and the trial bar view these healthcare organizations as having integrity and seem to be more willing to treat them fairly. It’s all about restoring trust!

On Thursday, November 12, Sorry Works! will be hosting a webinar on how to start and sustain your disclosure program. Sorry Works! Founder Doug Wojcieszak will be teaching from the new Sorry Works! Tool Kit — and every registrant will receive a copy of the Tool Kit. Click here to register.

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Sorry Works! at ASHRM – Booth 409 – with The Sullivan Group

ashrmSorry Works! Founder Doug Wojcieszak will be at ASHRM this Monday — Booth 409 — with our partners The Sullivan Group.   Sorry Works! and The Sullivan Group will be showcasing our new online course entitled, “Communication and Resolution: Empathy Post-Event.”  Wojcieszak will also be providing mini-presentations at 8:15am and 1pm on Monday at the booth — please stop by and see us.

If you are having any trouble finding us or would like to schedule a private meeting to discuss the new online course, call Doug’s cell at 618-559-8168 or e-mail

See you at ASHRM!

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Idaho Hospital Transparent, Apologetic After Child’s Death Due To Medication Errors

STLAccording to media reports, seven-month old August Dean Elliott died at St. Luke’s Magic Valley Medical Center due to a medication error.  The hospital held a press conference about the death, is investigating the event with the family and their attorney, and has apologized.  It looks like the hospital is handling the situation in an empathetic and intelligent manner.

Though this a tragic situation, it is good to see the hospital acting in this manner….in the not-so-recent past this behavior would have been unthinkable for a hospital.  The trick now is how to do we get every event (big or small, apparent or not-so-apparent) in every healthcare and insurance organization to be handled in this manner every time.  That day will come when every hospital and insurer has a disclosure program.

At Sorry Works! we are committed to helping organizations develop and sustain successful disclosure programs.  We recently launched the Sorry Works! Tool Kit to show organizations how to make disclosure work on a consistent and ethical basis  by developing successful and sustainable disclosure programs.  We are holding a November 12th webinar to teach from our new Tool Kit, and every participant will receive a copy of the Tool Kit.  To register for the November 12th webinar, click on this link.

Click on this link and this link to see media reports about the death of August Dean Elliott.

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Disclosure Documentary: Informed Consent Trailer & Pricing

dan hallThe Disclosure Documentary produced by Newport Classic Films and Dr. Steve Kraman and marketed through Sorry Works! is generating A LOT of interest. It’s a terrific movie that really gets people thinking about all of the issues surrounding medical errors and disclosure. And at 47 minutes in length, the documentary is perfect for Grand Rounds and other staff meetings.

Many experts from around the country provided interviews for the movie, including Dr. Dan Hall from the University of Pittsburgh Medical Center. A surgeon and ordained priest in the Episcopal Church, Dr. Hall offered an in-depth interview on informed consent. To see the trailer from Dr. Hall’s interview click here. To see Dr. Hall’s biography, click here.

INFORMATION ON PRICING FOR MOVIE: We are charging $500 for the movie for one hospital, practice, or nursing home. Organizations with multiple facilities (a chain of hospital or nursing homes, for example) or an insurer or association with many members should call 618-559-8168 or e-mail for a quote. To order the documentary, click on this link.

To see a trailer for the movie, click on this link.

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