"I am Mrs. Smith:" - True Story From Disclosure Training Session
I am now beginning my disclosure training sessions by sharing the following actual case with my audiences: "Mr. Smith is a 53 year old man who went to the hospital for a CT guided biopsy of the liver. Mr. Smith believes the test is no big deal and tells his wife to go shopping. The technician assures the wife that they will call when the test is complete.
Mrs. Smith is standing in Macy's when her cell phone rings. She hears a nurse frantically screaming, 'Come quickly! Come quickly!'
Mrs. Smith runs back across the street to the hospital, but by the time she arrives her husband is dead."
After reading through this scenario I ask my audience members - MDs, RNs, risk managers, hospital administrators, etc - to tell me how they are going to communicate to Mrs. Smith. I put it to them. What are YOU going to say? What issues will YOU discuss? How will YOU say it? What are YOU going to do for Mrs. Smith?
I am usually met with silence and lots of people squirming in their chairs and looking away from me. It's very uncomfortable for audience.
After some prodding from me, people will start offering some hesitant thoughts. Some want to talk about informed consent. Others want to start providing medical speculation. And then others say - correctly - we just need to focus on empathy, promise a review, and meet the immediate needs of Mrs. Smith as well as the staff who were involved. Can we help Mrs. Smith call her children? Sit with her. Make sure she can get home safely. Tell Mrs. Smith we are sorry this happened and we will be doing a review. One of the nurses during a talk said it is so important to simply have a presence with a family after something goes wrong.
It's a great training case....because something bad happened but you don't how exactly it happened. The urge is to assume there was a mistake, but it could have also been a heart attack! The point I drive home is doctors and nurses as well as patients and families aren't ready to talk "medicine" post-event. You need to focus on feelings....basically do grief counseling joined with intelligent, thoughtful customer service. This case also does a great job demonstrating the need for disclosure training for front-line docs and nurses....the stony silence after sharing this case is proof positive that training is desperately needed!
So, after this case I run through a few more cases, then I go on with my slides about how we teach disclosure to front-line docs and nurses and also how we help risk, claims, legal, and c-suite think through cases, followed by Q&A. At the end of one presentation, however, a female doctor raised her hand and said the following: "I am Mrs. Smith....I am the Mrs. Smith in the case you shared."
You could have heard a pin drop in the room.
Now, the female physician wasn't the actual Mrs. Smith from my case, but she lost her husband to a similar set of circumstances. She shared a lot of the details of her story with me and the audience...it was tough for her. I sat down and listened to her. The female physician said that when her husband died the doctor muttured "sorry," dropped his head, and immediately walked out of the room never to be seen again. The nurses, however, stayed with the female physician - a new widow - and her family. They held hands, provided comfort, and were that presence. What the nurses did for this woman and her family will never be forgotten. Why couldn't the doctor do the same?
You know when the science of medicine fails you (either because it was a known complication or an error), you have to rely on the emotional stuff to get you and your patient/family through the situation. I'm talking about empathy. Talking about having a presence. I'm basically talking about basic grief support combined with some thoughtful customer service. I know this stuff is uncomfortable for doctors and some nurses because you are trained to fix things, and you often can't fix these situations. You're not Jesus Christ with Lazarus...your medical/scientific training is useless in this regard. But it doesn't mean your patients and families need you any less. When a patient or family is emotionally traumatized, the best thing anyone can do is to simply be there, even in silence. Don't worry about the medicine.
After the female physician was done sharing her story, several other doctors in the room opened up and shared their feelings and a few stories. One doctor told of a patient who died six weeks earlier and he wondered if it was OK to send a sympathy card to the family. Absolutely. Another doctor said when a patient dies he feels pushed to quickly get onto the next patient. Don't feel pushed.
Every audience gives me energy and hope. This audience gave me a little extra energy and reason to get up early every morning. We have A LOT of work to do, but it's worth the effort!
Enjoy the rest of your day!