Patient Confronts Doctor Over Missed Cancer Diagnosis
Yesterday I came across an article on Facebook about a female patient in her thirties confronting an orthopedic surgeon who missed a cancerous tumor in her knee. Long story short, the surgeon operated several times on a young woman who injured her knee in a hiking accident. Four surgeries later, the knee was still not improving, the surgeon released the patient, she found another surgeon who recommended knee replacement, and, surprisingly, during the knee replacement surgery found the rare, cancerous tumor. By the time the cancer was diagnosed it had spread to the patient's spine, liver, kidneys, and lung, and she has been battling the cancer now for over three years. The patient -- Elisabeth Finch -- is a little different than the "average" patient. You see, Ms. Finch is a writer for the popular medical soap opera "Grey's Anatomy." And what Ms. Finch did with this situation is also not "average" for most patients and families confronted with a similar situation: She made an appointment with the surgeon who missed the cancer.
What she got from the original surgeon, unfortunately, was not so great: legal mumbo jumbo about sign this paperwork before we talk so I know you are not suing me, and then not much empathy. As Ms. Finch describes the encounter in the article, the meeting with the surgeon was a major let down.
I think this is a powerful article to share with clinicians. Great teaching tool.
We want patients and families to come back post-event....we want them calling, e-mailing, writing a letter, showing up in the exam room, etc. Doctors have traditionally been scared of these encounters, but this is the best thing that can happen with an angry patient full of questions. I always challenge my physician audiences by telling them they should want to maintain relationships/communication with consumers post-event lest their upset patients find new friends: lawyer, regulator, member of the media, etc.
However, many patients and families are not Elisabeth Finch who reads medical journals, talks to physicians and nurses on a daily basis for her job, etc. Not many folks would know to do what she did...so we have to tell them! For several years we have offered the Patient/Family Education documenton the Sorry Works! website and have encouraged folks to download it, use it, change it to fit their needs, etc. This document is literally a message to patients and families: Come back to me if you are not happy....the door is always open. Moreover, part of developing a disclosure program is sending a loud message to your patient population and outside world: "We want to hear from you anytime you are unhappy. We are just a phone call away, and the door is always open."
However, when patients and families do walk back through that door, angry, upset, and full of questions, the doctor needs to be handle the conversation in an empathetic and intelligent fashion without prematurely admitting fault. Or hiding behind a legal document! To be totally candid, Ms. Finch's case may not be malpractice.....this was a rare form of cancer (for a woman in her thirties) and would a reasonably competent medical professional, operating on knee damaged in a hiking accident, be expected to catch this cancer, or not?? I dunno. But here's what I know should happen:
First, a physician should listen to everything this woman has to say...listen to every frustration, every question, and every tear. Show you are really listening with good body language in a quiet environment -- make the patient feel heard. Be respectful. Then, when the time is right, say something like the following:
"Ms. Finch....I am very sorry this happened to you. I feel terrible for you. You have questions, and so do I. I want to understand how this happened...I want to take a step back and review the entire situation, and get some outside experts to look at what happened too. I am simply shocked and upset at what has happened to you, and, again, I am sorry for everything you have been through. At some point soon, I also want to sit down and review everything with you...I want to interview you and get your recollections and feelings about the care you received from me. I want to re-connect with you next Tuesday to update you on my progress. Is there anything I can do for you right now?"
And you know what? The patient or family may think you are full of crap. Not believe a word you say. The snow job is coming, etc. All you can do is live your words, follow through, keep your promises, and hope to earn back the trust. And document everything.
Start by calling leadership or risk to get help with the review. Make the patient/family part of the review process, and stay in touch with the patient or family throughout the review process. Don't let months or even weeks pass without touching base....stay in touch! We recommend touching base at least once per week (possibly more). Don't ever let the patient/family feel abandoned. Re-build that relationship!
If the review shows the situation was truly malpractice, then the surgeon and his hospital/malpractice carrier should work to address the financial and emotional needs of the patient (while also working to bring closure for the surgeon). If there was no malpractice, the results of the review should be communicated in an empathetic and credible fashion, at worst, people will agree to disagree.
But to do this all of this, we first have to train clinicians about post-event communication, and we also have to send the message to patients and families that the door is always open. This is what a good disclosure program does.
To help your staff understand how to communicate post-event, remember to schedule a Sorry Works! presentation for 2016. Call 618-559-8168 or e-mail firstname.lastname@example.org.