Docs Still Need to Be Taught (Reminded?) What to Say Post-Event...

I begin every training session with a true case that was shared with me by a California risk manager...it's a routine test that goes tragically wrong: 

"Mrs. Woods is a 53-year old woman who goes to the hospital for a CT guided biopsy of the liver.  The staff assures Mrs. Woods the test is 'no big deal' so she tells her husband to go across the street to do some shopping during the test. The clinical team assures Mr. Woods they will call him when the test is complete.  Mr. Woods is standing in Macy's when his cell phone rings....he answers to hear a nurse frantically screaming, 'Come quickly!'  Mr. Woods races across the street to the hospital where he learns his wife is dead." 

Again, I read that case at the beginning of training sessions, and then I challenge my healthcare audiences with the following: "OK, for the sake of role playing let's pretend I am Mr. Woods. I was planning to take my wife home and enjoy a quiet evening, but, instead, I will be going to a funeral home because a routine procedure went tragically wrong. What are you going to say to me?" 

I then shut up and wait, and usually listen to the crickets chirp.   

Usually, a good 30 seconds to a minute of awkward silence passes. Somebody may utter a shy "sorry,' and a few more comments or ideas typically follow.  Some helpful, some not so helpful.  Most people look at their shoes hoping not to be called out...

Last week, I had a very honest doctor exclaim the following during the role play: "We don't know what to say!  We don't have any information...we don't know what happened, don't know if there was an error or not....we just don't know what to say!"  

Very honest answer, and a very telling answer too. Doctors and nurses know medicine, and they are very comfortable with data, clinical procedures, science, etc. Take all that stuff away and they might as well be naked....

I told the honest doc that my case scenario actually gives him and other clinicians many things to discuss, but, unfortunately, the case doesn't provide any the usual stuff you like to talk about!  The woman is dead, the medicine failed us (either through God's will or error), the husband is devastated, and so is the staff. Plenty to talk about.  So, I then broke it down for that doctor.  We first engage Mr. Woods with empathy and meeting immediate emotional needs, then promise a review with a follow up meeting scheduled right then (3pm tomorrow afternoon?), make sure Mr. Woods is cared for and can get home safely, and stay connected with Mr. Woods going forward.  I also told our honest doctor that you need to spend whatever time is necessary with Mr. Woods (other patients/families can wait; colleagues will cover for you).  I said much of the time spent with Mr. Woods may be in silence, saying nothing at all.  I once heard a police chaplain describe this quiet time as, "The ministry of the presence."  

Next time you have a gathering of doctors and nurses (Grand Rounds, staff meeting, etc?), throw this case up on a screen and assume the role of Mr. Woods.  I promise you will receive valuable data about the state of your disclosure efforts. 

Sorry Works! can help your clinical staff understand how to have these difficult discussions with patients and families.  Give us a call at 618-559-8168 or email doug@sorryworks.net.  

Sincerely,

- Doug

Doug Wojcieszak, Founder 
Sorry Works!
618-559-8168 (direct dial)
doug@sorryworks.net (direct e-mail)