Disclosure Scenario for Front-Line Docs & Nurses
When I begin Sorry Works! presentations the first Power Point slide has the following scenario for the audience: Mrs. Woods is a 53-year old woman who goes to the hospital for a CT-guided biopsy of the liver. The test shouldn’t be a big deal believes Mrs. Woods, so she tells her husband to go to the mall across the street and do some shopping. The technician assures Mr. Woods she will call when the test is complete. Mr. Woods is standing in the mall when his cell phone rings and he answers to hear a nurse frantically screaming, “Come quickly!” When Mr. Woods gets to the hospital he learns his wife is dead….
After reading through that slide I turn to my audience and say, "OK, I'm Mr. Woods.....I'm the guy who just lost his wife....what are YOU going to say to ME?"
Stone cold silence. Lots of uncomfortable looks around the room. Then I start getting animated.
"Somebody talk to me...somebody? Somebody! What the hell is going on here?! Why is my wife DEAD?!!"
I tell my audience that every second that passes with no communication or empathy damages the relationship with the family and heightens the chances of litigation and other acts of revenge.
Finally, usually, somebody will utter, "Well, I'd tell you 'I'm sorry.'"
To which I reply, "Oh, you're sorry....how exactly are you going to say sorry to me? In what context will you say sorry?"
Stone cold silence.
"Are you sorry in an empathetic way, or sorry that your gross incompetence killed my wife? Are you sorry that I am going to sue you for millions of dollars, or simply sorry my wife died and you are going to review the situation? Well....what is it?!?"
At this point, people are getting real quiet and very uncomfortable.
I've had audiences where some doctors start muttering about informed consent or speculating how the technician running the test must have screwed up, but, then usually a nurse will bark the following from the back of the room: "Honey, Mrs. Woods could have had a heart attack totally unrelated to the test...we don't know what happened, except she is DEAD!"
Absolutely....very often we don't know what happened in the immediate aftermath of an adverse event. Hunches can often be wrong. The power of this scenario is that it literally invites the audience to assume there was an error, but, as the nurse said it could have been a heart attack (or something else). I tell my audiences that the known truths in this scenario are 1) Mrs. Woods is dead, and 2) her husband and the staff are traumatized...that's it! We need to forget about science and technology, simply be present for Mr. Woods and help him through the worst moments of his life, be empathetic, which includes sorry in proper context, and continue working to stay connected to Mr. Woods and his family. That's all you can do. Yes, you can say at some point a review will be conducted, but you can NOT start speculating about the care or have a discussion about informed consent. Simply be empathetic and be present.
I then offer my audiences a different scenario: As your speaker I am a 43-year old man, in good health, avid runner and very active, BUT, bad things can happen to 43-year old men. If I were to collapse on the floor in the next minute what would you guys do for me? Well, very quickly I have doctors and nurses speaking over each other to tell me how they would rush to my side and begin to address my medical needs. At that point, I stop the audience and ask what are the differences between these scenarios? There are two major differences. First, doctors and nurses have been trained how to handle 43-year old men who collapse in a heap BUT have not been trained how to communicate with a family after an adverse medical event. Second, doctors and nurses are very comfortable doing medicine, but have no idea what to do when the medicine fails them.
This approach really captures the attention of my audiences. I say, "Look, now you see why we are here today...you need training on what to do and say when the Mrs. Woods scenario happens. You need to know what to do when the medicine and technology fails and you have to deal with an angry and grieving family. Silence is unacceptable. Running away is unacceptable. Saying things in the wrong context is unacceptable. You need to know what to say and how to say it...you need to know how to stay connected with your patients and families after an adverse event, and today we are going to teach you how to do it!"
After one of my presentations, a female doctor in her mid-50's raised her hand during Q&A. I called on her and she announced to a room full of colleagues that the "Mrs. Wood scenario" actually happened to her recently with the death of her husband. The doctor went on to describe how her husband's physicians froze, went silent, and simply left the room, BUT the nurses stayed with her, held her hands, helped make phone calls to family members, and made sure she got home safe. My audience was silent again, except this time one of their colleagues was teaching them.
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