The Importance of Disclosure to the Grieving Process

sad

When most people lose a family member or close friend, they go through the “classical” stages of grief: Denial, anger, bargaining, depression, and, finally, acceptance.  Grief counselors often say that everyone grieves at a different pace, and not everyone journeys through grief in a linear or straight-line fashion. One day you’re doing great, but the next morning feels like you are back at the starting line, and so on. You can even go months or years without crying, but then a certain sound, smell, song, or something else leaves you sobbing. To me, this is what grief is like for a “normal” death….passing of an elderly person, or a sickness that could not be stopped despite the best efforts of healthcare professionals.

What about a tragic death, though?  I think when you are dealing with an unexpected passing that could have been prevented, grief can be more challenging, especially if there are no answers, justice, or “closure” for a family.  People can become stuck in grief, especially at the anger and depression stages. They have difficulty moving forward with their lives because they are forever back at that moment in time when their loved one was inexplicably taken. Relationships with family members and friends can splinter as some folks are able to move forward, while others cannot. “Why can’t Mom just let it go?” can become fighting words within a family or a relationship. People faced with such grief want answers, accountability, and the knowledge that someone or something learned from the tragedy and are doing everything possible to make sure it never happens again — and these sad souls may never reach this place. 

And as tough as a tragic death can be, it can be even worse with a preventable crippling or life-changing injury that drains a family’s finances, time, patience, and energy.  This might be the most horrific type of grief, especially if there are no answers or help from the offending party.

I want you to think about this column the next time you and your organization are dealing with a potential medical error. Remember this column when a lawyer or claims manager suggests fighting a case that everyone knows is a medical error. Through my work in Sorry Works!, I have met one too many people who are literally trapped in grief because they received no answers, closure, or accountability after a medical error. People lose families and friendships because they simply can’t get past what happened at the hospital or nursing home. Good people literally drive themselves and those around them crazy in a fruitless search for the truth.  It’s torture.

So, the next time you and your organization consider doing something other than disclosure, remember you are literally messing with the mental health of another human being.

As you begin scheduling Grand Rounds presentations for this fall and winter, remember Sorry Works! We provide CME-accredited presentations for physicians, nurses, and the entire organization. For more information, call 618-559-8168 or e-mail doug@sorryworks.net.

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Project for this Fall: Teaching Your Docs, Nurses How to Say “Sorry”

crying docKids are headed back to school, the air (in some parts of the country) is starting to feel a little crisp, and football is once again on TV. The lazy days of summer are in the rear-view mirror, fall is around the corner, and time to get re-focused on priorities. Make teaching disclosure to your staff at the top of your list. Seriously, if you don’t take time to teach your staff how to stay connected with patients/families during post-event discussions they will continue to stumble and too often get your organization sued. You can spend a truckload of cash on lawsuits, lawyers, and payouts on the back end, or a relatively small price on the front-end training your staff how to say “sorry.”

Unfortunately, most physicians and nurses were never taught how to communicate following adverse medical events. We are reminded of this reality in this recent news article. Dr. Tom Gallagher is quoted as saying he and other physicians were never taught post-event communication techniques in medical school.  Most docs and nurses can relate.

This will only change if we make teaching disclosure a priority. Yes, I know budgets are tight, and time is limited, but we know you are going to spend X amount of bucks and Y amount of time annually dealing with complaints and litigation…it’s just a given.   Every organization that has implemented disclosure has seen litigation cost figures significantly reduced while patient safety parameters have increased — but they had to train their people. They had to make that upfront investment.

Many organizations have used The Little Book of Empathy to teach their docs, nurses, and other staff how to stay connected post-event. The Little Book of Empathy costs between $4 to $9.99 per copy depending on volume, it’s customizable, and it’s a quick read (30 minutes or less) for even busiest doc or nurse.  And several organizations have also purchased the Sorry Works! Tool Kit which has everything you need to start and sustain a successful disclosure program.   The Tool Kit is great for c-suite, risk, claims, legal, and medical leadership.  To order the Little Book of Empathy or Sorry Works! Tool Kit, simply click on this link.

Sorry Works! is also available for CME-accredited Grand Rounds presentations to your physicians, nurses, and staff. For more information, call 618-559-8168 or doug@sorryworks.net.   To see a sample list of organizations that have scheduled Sorry Works! presentations in the past, click on this link.

Sorry Works! can help you make disclosure a priority this fall — just call 618-559-8168 or e-mail doug@sorryworks.net.

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Little Book of Empathy for Front-line Staff, Customizable Too

Booklet2ndEdition_webOver the past five years we have literally sold thousands of copies of the Little Book of Empathy to hospitals, nursing homes, and medical practices throughout the United States and around the world. This compact, inexpensive text shows front-line staff in 30 minutes of less how to stay connected with patients, residents, and families after something goes wrong without prematurely admitting fault. The cost is from $4 to $9.99 per unit, depending on quantity, and bulk order prices are available.

Moreover, we can customize the Little Book of Empathy for your organization…we can put your logo on the cover, include a welcome message from your leadership, put your risk or claims contact information on the back cover, and even sprinkle quotes from leadership throughout the text. Get as creative as you would like. To discuss customization options, simply call 618-559-8168 or e-mail doug@sorryworks.net.

To order your copy of the Little Book of Empathy, click on this link. To learn more about the Little Book of Empathy, click on this link.

The Little Book of Empathy will show your staff how to say “sorry” following adverse events, how to be supportive of patients/residents and families and also colleagues, and encourage staff to immediately report incidents to leadership. It’s a great risk management tool, and the investment you make will be returned many times over.

Again, you can order your copy (or copies) of the Little Book of Empathy by clicking on this link.

Sincerely,

Doug Wojcieszak, Founder, Sorry Works!

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Lawyers Still Pooping on Soldiers? Issue for Obama, Presidential Candidates?

armyLast fall we wrote a column in this space concerning how the military appeared to be establishing a disclosure-type program for military medicine. At the time we praised this effort, albeit with some caveats. According to the publication Military Times, the program would not determine fault or errors, and the program’s participants would cease communication with the patient/family if litigation ensued. We wrote in our piece changes were needed in these facets of the military’s approach to be considered a true disclosure program. See here for the original blog post from November 2015.

Well, within the last month, Military Times published a lengthy article on the state of medical malpractice cases in military medicine, and, this time, it was NOT a rosy picture of disclosure, apology, reconciliation, etc. It was the exact opposite. Many med-mal cases involving military personnel are potentially subjected to the Feres doctrine, which is a 1950 Supreme Court case (Feres v. United States) regarding a medical malpractice lawsuit filed by an active duty solider. In that case, the U.S. Supreme Court ruled that active duty soldiers could not sue the government for injuries or deaths caused by mistakes of their military brethren. I’ve had several military personnel explain to me that our armed forces don’t want soldiers or their family members suing the government because a commander gave an order in battle that led to injury or death — which I think makes sense. What I don’t understand — and many people are befuddled along with me — is how the Feres doctrine can be applied to a state-side military hospital where negligent medical care is rendered. The recent Military Times article provided an example of a soldier giving birth to child, the child suffering significant birth injury which led to crippling, life-long injuries, BUT the family’s medical malpractice lawsuit has been rejected by two courts that invoked the Feres doctrine.

The military responds to these arguments by saying they provide a work-comp like system for injuries sustained due to medical errors from military medical care. But, military families still feel cheated. It’s not only the compensation piece that may be lacking in some of these cases, but also the lack of accountability and improving medical care for future soldiers, as well as apology and disclosure. Military families are no different than the rest of us…they want answers and honesty after something goes wrong. And our military families feel cheated when their cases — which would be easily pursued if they were civilian — are blocked by a 66-year old Supreme Court ruling.

Here is another article from Military Times on this issue.

In reading these different articles and in thinking about conversations I have had with military people, two themes are constantly reinforced: 1) It’s not fair; and 2) military medicine will never improve unless there is accountability (which includes the threat of litigation).

Thinking broader, disclosure and apology may never fully take root in military medicine unless soldiers and their families have the same access to the courts as the rest of us. Even broader, soldiers and sailors fight and die daily for our freedoms, including the right to go to court, but our service members cannot partake in these rights when they come home?

And fairness to me with this issue is a soldier should not have to battle terrorists in Afghanistan, Iraq, or wherever they are stationed only to come home and have a lawyer hang the Feres doctrine over their head.

Politicians from both parties love to talk about supporting the troops. To me, this issue is a slam dunk….not only is the right thing to do, but, just like civilian healthcare, disclosure and apology will save money in the long run for military medicine. Perhaps this is an issue for President Obama to address in the closing days of his administration — as we wrote in this post in May 2015 — and it also should be an issue for Clinton and Trump to address on the campaign trail this fall.

 

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Gag Order/Confidentiality Project from Sorry Works! — need your opinion

gagIn a recent Sorry Works! e-blast about the toddler dying during a dental procedure, there was a quote from a dental professor claiming that most malpractice settlements have gag orders or confidentiality clauses. Here is the quote: “When there are malpractice suits, settlements often include a gag order that prohibits plaintiffs from talking about it, according to Dr. Joel Weaver, a dentist anesthesiologist and emeritus professor of the Ohio State University Medical Center.

This touched a nerve with some readers, and, to be frank, I have heard numerous complaints about this topic over the last eleven years from both clinicians and consumers. Both sides basically saying the same thing, namely how can medicine improve and learn from events if we don’t talk about lawsuits and closed claims? Many clinicians tell me they see or hear about adverse events, but then the lawyers sweep in, everybody clams up, and they (the clinicians) never find out what happened with a particular case. I have had countless nursing managers and front-line physicians state that cases literally disappear into a black hole.

How can we expect medicine to improve with such behavior?

Look, some estimates peg medical errors as the third leading cause of death (behind cancer and heart disease) in the United States. When it comes to cancer and heart disease we can’t — rightly — stop talking about these villains. There are countless news stories and books about life and death with cancer or heart disease from the perspective of patients, families, and clinicians. There are Facebook pages, fundraisers, rallies, t-shirts, etc, etc. But medical errors? Eh, shove it under the rug!

I want Sorry Works! to work on this issue. Now, I do NOT envision lobbying for passage of laws, or asking for regulations to be changed. In fact, I don’t want anything to do with out dysfunctional political system — just look at the Presidential race! Sorry Works! has been successful over the years because we have completely side-stepped politics and, instead, focused on education and awareness which has shown healthcare professionals they can fix the malpractice crisis on their own with disclosure. I intend to do the same with gag order/confidentiality issue…show people why it is in their own best interest to change their behavior.

Here is where you come in: What is your opinion of gag orders, or the reasons for having confidentiality clauses? Does your hospital, nursing home, or insurance company use gag orders? If yes, why? If no, why? Why do lawyers and executives from hospitals and insurers insist on gag orders or confidentiality clauses? And really important question: How often are gag orders or confidentiality clauses inserted in settlements? Some lawyers have told me that gag orders or confidentiality clauses are simply another “check box” on the way to settlements that no one really thinks about…is this true? If you are a med-mal lawyer, what has been your experience with confidentiality clauses? Is this issue more urban legend than fact? Is this the monster under my six-year old’s bed, or are gag orders a real problem that need to be addressed? Please share your thoughts and experiences with me by e-mailing doug@sorryworks.net or calling 618-559-8168. Your answers will be completely confidential.

Sorry Works! will publish a paper on this topic in September.

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Interview Request from Medical Economics…

MEFrom time to time, I do interviews with medical, insurance, and legal publications as well as popular/general media outlets.  Conducting interviews with credible media outlets is a terrific way to spread the message of disclosure.  Recently, I was interviewed by Jim Sweeney of Medical Economics. Very good interview, and Jim has a request of Sorry Works! readers…he is looking to interview “any internal medicine physicians who have experience in apologizing to patients and would be willing to be interviewed on the record for Medical Economics.”

To respond to this request, you can either reply to this e-mail, or contact Jim directly at jfsweeney61@gmail.com.

With a circulation of 188,000, Medical Economics is published for primary care physicians (internists and family practitioners), cardiologists, and practice managers in office-based, independent practices. Medical Economic’s mission is “to provide physicians and medical practice managers with practical, up-to-date advice, information and news of emerging trends they need to succeed in today’s fluid, highly competitive environment.”

If you would like to speak with Jim, either respond to this e-mail or contact him directly at jfsweeney61@gmail.com. Also, please forward this e-blast to colleagues who might be interested in speaking with Jim.

Have a terrific weekend.

Sincerely,

 

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Microsoft Designer Paralyzed by Hospital….Now Working with Hospital

augustAugust de los Reyes, a former top Microsoft Designer, suffers from an autoimmune disorder known as anklylosing spondylitis, or AS, which makes his spine brittle and susceptible to fracture even from minor trauma. Three years ago, August fell out of his bed and felt significant pain, so he went to the ER at Overlake Hospital in Bellevue, Washington. Mr. de los Reyes specifically told doctors of his medical condition and susceptibility to brakes in his spine, but the doctors assured him there was no break — even though an x-ray showed an undetected hairline fracture in the spine. Doctors sent him home. Mr. de los Reyes went back to the hospital’s ER twice over the next two weeks, the last time complaining of excruciating pain and tingling in his legs. While being positioned for MRI scans, Mr. de los Reyes was paralyzed from the waist down and will never walk again.

According to news accounts, August de los Reyes experienced all the feelings and phases of grief following his injury, from anger and sadness to wanting to know this error would not be repeated with another patient or family. When looking for a law firm to represent August, his sister settled on the Luvera Law Firm and attorney Robert Gellatly because the firm does not accept confidentiality orders in med-mal settlements. Mr. Gellatly told CNBC that gag orders do “not serve the public interest.”

Well, long story short, the lawsuit was successful with the hospital paying $20M to August de los Reyes, but there was an unusual twist…something attorney Gellatly has never seen in 30 years of med-mal litigation: August de los Reyes and the hospital are now working together to redesign systems and improve patient safety processes for this hospital and other medical facilities.

As a designer, August de los Reyes has skills and knowledge that are very useful in helping analyze problems and propose fixes. Moreover, according to the CNBC article, Mr. de los Reyes is bringing in other designer colleagues to help Overlake Hospital. August is adamant about learning from his case to not only help Overlake Hospital, but also other hospitals and healthcare organizations.

Here is the link to the CNBC article featuring Mr. de los Reyes’ story.

 

Some take-aways and questions for YOU from this story:

1) What does your settlement process look like….are you open to using the shared story with an injured patient/family to improve your healthcare delivery systems, and also share that learning with other healthcare organizations?  Or do you have defense attorneys and claims managers who seek to seal up everything and slam the door shut on any chances of reconciliation? Have you even thought about this issue?

2) Healthcare can be a closed fraternity or sorority….if you didn’t come up in healthcare you are not welcome, outsiders need not apply. Are you open to the knowledge and experiences available from outsiders, even when those people are patients and families you may have harmed?

3) What are you doing to truly reconcile with your patients and families after legitimate medical errors have caused harm?  What are you doing beyond cutting a check?  Now, not every patient/family will be a former Microsoft designer who can analyze your systems, nor will many folks even be right for a patient safety committee, but almost every person injured by events (including your clinicians) need reconciliation and healing…what are you doing in this arena? There are multitude of things you can do that will creatively meet the emotional needs of all stakeholders, and bring true peace. Have a plan in place as part of your disclosure program….

This is a GREAT article to share with colleagues…it will generate discussion and introspection, which is what we want.

Finally, remember, nominations — including self-nominations — for July’s Sorry Works! Tool Kit are due next Thursday, July 28th by e-mailing doug@sorryworks.net

Best,

– Doug

Doug Wojcieszak, Founder, Sorry Works!

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Hospital Encourages Mom to Tell Story of Near Fatal Dosing Error

sick kidsBaby Elliot Jones was born six weeks premature and had to endure life-saving surgery in his first week of life, but he quickly recovered and was doing well when a nurse at Toronto’s Hospital for Sick Kids accidentally gave him morphine — instead of heparin — and Elliot coded. Fortunately, the staff was able to reverse the effects of the morphine and save Elliot’s life….and then they came clean about the mistake. Moreover, they encouraged Elliot’s mom — Melissa — to share her story. Hospital for Sick Kids also showed Melissa Jones how the mistake was fixed and even invited her to join a safety committee at the hospital. Great story of transparency, reconciliation, and creative problem solving. It’s what disclosure should be all about.

Dr. Lawrence Roy, a staff anesthesiologist at SickKids with over 30 years experience told The Globe and Mail “that years ago, if someone made a mistake dispensing medication, parents would be told their child had a ‘drug reaction.'”

Here is the article which tells the whole story, and patient safety leaders in acute and long-term organizations will find a lot of interesting information and ideas in this very detailed article. It’s a good read…I strongly encourage you to click on that link. However, what I found most compelling about this tale is the fact that the hospital is encouraging mom to share her story with the world. As many Sorry Works! readers know, we are developing a project on gag orders or confidentiality clauses in medical malpractice settlements. Too many patients and families as well as staff feel, believe, or have been told they canNOT talk about closed cases. We want to know your experiences, opinions, and thoughts about closed cases and gag orders. Please e-mail doug@sorryworks.net or call 618-559-8168. All responses will be kept confidential.

Here is the link for the Sorry Works! gag order project….please read and share your opinion and experiences with us. Again, e-mail me your thoughts and experiences to doug@sorryworks.net and all responses will be kept confidential.

 

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Gag Order/Confidentiality Project from Sorry Works! — need your opinion

gagIn a recent Sorry Works! e-blast about the toddler dying during a dental procedure, there was a quote from a dental professor claiming that most malpractice settlements have gag orders or confidentiality clauses. Here is the quote: “When there are malpractice suits, settlements often include a gag order that prohibits plaintiffs from talking about it, according to Dr. Joel Weaver, a dentist anesthesiologist and emeritus professor of the Ohio State University Medical Center.

This touched a nerve with some readers, and, to be frank, I have heard numerous complaints about this topic over the last eleven years from both clinicians and consumers. Both sides basically saying the same thing, namely how can medicine improve and learn from events if we don’t talk about lawsuits and closed claims? Many clinicians tell me they see or hear about adverse events, but then the lawyers sweep in, everybody clams up, and they (the clinicians) never find out what happened with a particular case. I have had countless nursing managers and front-line physicians state that cases literally disappear into a black hole.   Conversely, patients and families feel threatened they will lose their home, savings, etc if they talk publicly about their cases.

How can we expect medicine to improve with such behavior?

Look, some estimates peg medical errors as the third leading cause of death (behind cancer and heart disease) in the United States. When it comes to cancer and heart disease we can’t — rightly — stop talking about these villains. There are countless news stories and books about life and death with cancer or heart disease from the perspective of patients, families, and clinicians. There are Facebook pages, fundraisers, rallies, t-shirts, etc, etc. But medical errors? Eh, shove it under the rug!

I want Sorry Works! to work on this issue. Now, I do NOT envision lobbying for passage of laws, or asking for regulations to be changed. In fact, I don’t want anything to do with out dysfunctional political system — just look at the Presidential race! Sorry Works! has been successful over the years because we have completely side-stepped politics and, instead, focused on education and awareness which has shown healthcare professionals they can fix the malpractice crisis on their own with disclosure. I intend to do the same with gag order/confidentiality issue…show people why it is in their own best interest to change their behavior.

Here is where you come in: What are the arguments for maintaining the status quo? Why do lawyers and executives from hospitals and insurers insist on gag orders or confidentiality clauses? And really important question: How often are gag orders or confidentiality clauses inserted in settlements? Some lawyers have told me that gag orders or confidentiality clauses are simply another “check box” on the way to settlements that no one really thinks about…is this true? If you are a med-mal lawyer, what has been your experience with confidentiality clauses? Is this issue more urban legend than fact? Is this the monster under my six-year old’s bed, or are gag orders a real problem that need to be addressed? Please share your thoughts and experiences with me by e-mailing doug@sorryworks.net or calling 618-559-8168. Your answers will be completely confidential.

Sorry Works! will publish a paper on this topic during the third week of July.

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UPDATE — Sexual Assault Victim, Oregon State Univ. Provide Powerful Example for Hospitals/Nursing Homes

RILEYEarlier this year, a friend in Oregon sent me a story about a young woman who was raped by four Oregon State Football players in 1998. Long story short, the school initially shoved the case under the rug, but, under a new President the school apologized and hired the woman — Brenda Tracy — to consult on sexual assault prevention. Powerful story of disclosure and reconciliation.

But it gets more powerful.

My Oregon friend sent me an update on the story this week.  At the time of the rape (1998), Oregon State was coached by Mike Riley, who is now the head football coach at the University of Nebraska. Riley invited Tracy to Nebraska to meet with him and his entire football team. They hugged and cried, and Brenda got a chance to ask every question of Riley she had wanted to for over 18 years. Later, Brenda talked to the entire football team, and told the players that for a time she hated Riley more than her rapists.

There was this powerful quote from one of the news stories that will sound familiar to Sorry Works! readers: “We talked about how it’s OK to say sorry. It’s OK to be accountable. It’s OK to stand up and say, ‘I didn’t do something right,’ or ‘I did something wrong,’ and move on from there. Sometimes when you wrong another person, all they really want is an apology.”

Gee, does that sound familiar?

My Oregon friend said this story could just as easily be about medical malpractice: Something bad happens in a hospital or nursing home, leadership and staff shut down, patient or family suffers for a long time, but, eventually, integrity creeps in and everyone has a chance to reconcile and bring a lot of good out of bad.

What can you and your hospital or nursing home learn from this story? How can you make Brenda’s story YOUR story?

Below is our original post, and here and here are news stories from Brenda’s recent visit with Coach Riley and the Nebraska football team.

 

Sincerely,

– Doug

Doug Wojcieszak, Founder, Sorry Works!

 

 

****** Original Sorry Works! post from this Spring

A friend recently sent me an article about a young woman who had been gang-raped by Oregon State University football players in the late 90’s, the school and local prosecutors shoved the case (and the woman) under the rug…and then sixteen years later the school made the situation right.

The victim, Brenda Tracy, had been unable to let go and was in therapy in 2014 when she contacted Oregon State University to talk about her case — and got nowhere. So, she went to the media. Ed Ray, Oregon State’s President, ordered an investigation, and three weeks later personally met with Ms. Tracy to deliver a tearful apology. But President Ray went even further…he hired Ms. Tracy to consult on sexual assault at the Oregon State Campus. Today, Ms. Tracy regularly speaks to and works with Oregon State sports teams and other student organizations to improve awareness and sexual assault prevention. It’s a powerful story and example.

A lot of parallels with this story and medical malpractice. Just like hospitals and nursing homes, many universities and colleges don’t handle allegations of wrong doing in a proper manner. University administrators, worried about the image of their school and keeping rich donors happy, often bungle investigations and fail to stay connected with victims and their families or offer appropriate support. Follow through and tangible change are often completely missing. A lawsuit may follow and possibly a settlement, but the settlement usually only involves money (no apology or admission of fault) and typically freezes out a potential change agent: The victim. Take your money and get lost is the message.

Sound familiar?

So, you want to change your hospital, eh? Or really make your nursing home top notch? Well, your best resource is the patients and families you’ve harmed. Now, I know — I know very well — that not every patient or family is equipped for this work. Moreover, some folks may be a perfect fit but have no desire to participate. But, if you have an open heart and are willing to look you will find many people who are both equipped and willing to help your hospital or nursing home. Nothing sends a message to doctors and nurses like the following: “My name is XXX, I lost my mother at this hospital…today, I am going to share with you my mother’s journey through this hospital due to medical errors, and then we are going to talk about making sure this type of tragedy never happens again.”

Moreover, don’t be afraid to really involve patients and families. By “really involve” I mean more than sticking them on the back end of a patient safety committee overloaded with docs, nurses, and other in-house staff. Use these people….put them to work, and don’t be afraid to listen to their ideas.

The Sorry Works! Tool Kit had many ideas and examples of how to include patients and families in your quality improvement processes. Click on this link to order the Tool Kit today.

 

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