Question from the Road: Boss Says "NO" to Disclosure?

June 21, 2010Doug Wojcieszak, Founder & Spokesperson Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net

Question from Road: Boss Says "NO" to Disclosure? I recently spoke at the American Academy of Physician Assistants meeting in Las Vegas, and we had to ponder the following question:

"As a PA, what should I do if I believe a medical error occurred, but my supervising physician doesn't believe in disclosure, doesn't want to tell the patient or family, no apology, etc?"

Tough question! It really is! And the question is really translatable to any number of professional relationships and settings, such as "My partner says NO to disclosure" and "The hospital risk manager says NO to disclosure" and "The insurance company says NO to disclosure" and so on.

What do you do? You have ethical and legal responsibilities as well as the real-world responsibilities of continuing to put food on your table, especially in this economy!!

Let's start by backing up the bus down the road.

First, we have always recommended that the time to have "the discussion" about disclosure is long before an adverse event ever happens. Talk with your boss, your partner, the hospital risk manager, insurance company, etc, and try to get an understanding ahead of time how adverse events will be handled. What are we going to say, not say, who says it, when do they say it, etc, etc? This is all part of developing a disclosure program. Remember, disclosure is not an ad hoc deal.

If, however, the answer from the boss, partner, insurer, et al is NO to disclosure, then try to change hearts and minds...and we have a load of resources here at Sorry Works! to help that cause. In the end, however, if you can't change the mind of the other party, you seriously need to ask yourself do I want to work for this person or with this person or do I want this person handling my risk or do I want this company insuring me? You need to really think, and do it now before faced with an adverse event. And if you leave the situation because disclosure is not supported, please make those feelings known! Difficult, yes, but this is how we push the culture forward!

So, what if we all agree on disclosure, have a disclosure program in place, etc, but, when faced with an adverse event not everyone supports disclosure or apology? Well, I think you need to talk with the other party....remember, we never want to rush to judgment with disclosure. Empathy quickly, apology only after an investigation has proven a mistake. You may believe a mistake occurred, but, you also may not be privy to all the facts and details of the case. Ask questions and confront if necessary, but keep an open mind, and work to change hearts and minds, if necessary.

But, what if it's clear a mistake occurred - no doubt about it - but another person and/or entity is blocking disclosure and the apology to the patient and family? Well, the situation needs to be confronted because the offending party is now breaching ethical and legal boundaries and asking/demanding you participate in the crime. Insurance fraud and all sorts of bad stuff going on. Obviously, every situation is different, but there are some commonalities to every scenario. In the short term, the disclosure program in your hospital, insurer, etc may have a hotline to make anonymous reports (if not, consider building a hotline into your program), or you may possibly consult with a lawyer who is ethically in tune with you and learn about your options. Long term, find a different job, partner, hospital risk manager, insurance company, etc.

For more information on Sorry Works! presentations and training seminars, please call 618-559-8168 or e-mail doug@sorryworks.net.

Sincerely,

- Doug

Doug Wojcieszak, Founder Sorry Works! PO Box 531 Glen Carbon, IL 62034 618-559-8168 (direct dial)