Study: Behind-The-Scenes Docs & Disclosure...

June 27, 2010Doug Wojcieszak, Founder & Spokesperson Contact phone/e-mail address: 618-559-8168; doug@sorryworks.net

STUDY: BEHIND-THE-SCENES DOCS & DISCLOSURE There was a study released recently on anesthesiologists and disclosure - the abstract is below. I tagged this newsletter "behind-the-scenes docs and disclosure" because what is true for anesthesiologists and disclosure also rings true for radiologists, the lab, some nurses, and other clinicians and staff who don't have as much face time with the patient or family as, say, the surgeon or other clinicians who have built a relationship. This is critical, because the hot-shot surgeon who has the trust of the grieving widow can choose not to disclose a team error and get everyone sued, or can pass the blame for his own mistake to the faceless anesthesiologist, who is now in the trick bag.

This is an important and serious issue, and we are glad this study is out there contributing to the conversation. And I think it ultimately argues for the development of disclosure programs, something we have long advocated for in hospitals, insurers, and practices.....and behind-the-scenes docs should be leading the charge for the development of disclosure program because they have the most to gain - or lose! Disclosure cannot be ad hoc because these so- called behind-the-scenes docs and staff are not heard from and can be sacrificed in the process. Disclosure must be fair & just for all participants in an adverse event, including the faceless team members not known to the patient or family.

Another point: We often hear the following from anesthesiologists and radiologists: "I don't have weeks, months, or years to build a relationship with the patient or family. Some of this relationship stuff as it pertains to disclosure and Five-Star doesn't apply to me."

Not true!

My typical response is I don't have weeks, months, or years to build a relationship with a flight attendant on Southwest Airlines or a manager at the Marriott Hotel...but I can tell you right away if I like them or not. It's their hello, looking me in the eye, how they listen and serve me, body language, and a whole check list of ways folks in this position can quickly gain trust with skeptical and jaded consumers. We need to teach these traits to our behind-the- scenes docs and staff, because they will surely need these skills in a disclosure process.

For more information on disclosure for all types of clinicians and staff, please contact Sorry Works! at 618-559-8168 or doug@sorryworks.net.

Sincerely,

- Doug

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

The Disclosure of Unanticipated Outcomes of Care and Medical Errors: What Does This Mean for Anesthesiologists? Karen J. Souter, MB, BS, FRCA* and Thomas H. Gallagher, MD

Abstract The disclosure of unanticipated outcomes to patients, including medical errors, has received considerable attention of late. The discipline of anesthesiology is a leader in patient safety, and as the doctrine of full disclosure gains momentum, anesthesiologists must become acquainted with these philosophies and practices. Effective disclosure can improve doctor-patient relations, facilitate better understanding of systems, and potentially decrease medical malpractice costs. However, many physicians remain wary of discussing errors with patients due to concern about litigation, the communication challenges of disclosure, and loss of self-esteem. As a result, harmful errors are often not disclosed to patients. Disclosure poses special challenges for anesthesiologists. There is often very limited time before the anesthetic in which to build the patient-physician relationship, and anesthesiologists usually function within complex health care teams. Other team members such as the surgeon may have different perspectives on what the patient should be told about operating room errors. The anesthesiologist may still be physically caring for the patient while the surgeon has the initial discussion with the family about the event. As a result the anesthesiologist may be excluded from the planning or conduct of the important initial disclosure conversations. New disclosure strategies are needed to engage anesthesiologists as active participants in the disclosure of unanticipated outcomes. Anesthesiologists should be aware of the emerging best practices surrounding disclosure, as well as the training opportunities and disclosure support resources that are increasingly available. Innovative models should be developed that promote collaboration between all perioperative team members in the disclosure process. There are important opportunities for anesthesiologists to play a leading role in defining specialty-specific disclosure practices and to more effectively meet patients' needs for disclosure after unanticipated outcomes and medical errors.