Question from the Road: How Do You Handle "Gray" Cases?
When disclosure is discussed or taught, people (including myself) will often talk about clear-cut, perhaps extreme cases of error that caused harm or even death, and how disclosure coupled with apology, fair compensation, etc diminished the anger and provided quicker closure and healing for all stakeholders without litigation. These "big" cases are often discussed in the media and shared through social media. But, after a recent Sorry Works! presentation, a doctor asked the following question: "Most adverse events are truly 'gray,' where it may take awhile to determine if we made a mistake or not....what do we do in these cases? How should we behave towards the patient or family if we don't know what truly happened?"
It's an important question. Because with the big, readily apparent mistakes it's foolish to do anything but disclose because there is no way to cover up the harm! Any fool can see that covering up will only make the situation 1000x worse. But, with these gray cases front-line docs and nurses often are not sure, and they can easily retreat into bad habits, especially when they haven't been trained how to empathize and disclose! Communication shuts down with the patient or family. Relationships become frayed. Trust goes out the window. Clinicians try to justify their ethical lapses, or simply hope the patient or family has forgotten about the potentially bad care and will simply go away. The phone starts ringing at the lawyer's office.
The message we have been trying to pound into doctors and nurses over the last three years needs more pounding: "Be quick to empathize, but wait for the review before apologizing and admitting fault. Stay connected with your customers and be pro-active but take time before accepting responsibility. Empathy is appropriate 100% of the time, apology only after a mistake has been proven."
To help your staff understand, literally script post-event conversations for them. Spoon feed them and reinforce, reinforce, reinforce. We provide sample scripts with Dos and Don'ts in the Little Book of Empathy, which was written for front-line staff. Get some copies today and share with your staff.
Docs and nurses need to know it OK to be unsure post-event and consider a case to be "gray"....it's not OK, however, to retreat from your patients and families post-event. Patients and families need their doctors and nurses post-event, and we need to give clinicians the tools to deal effectively with these emotionally charged situations, because running away is a sure-fire way to get sued!