I'm Not a Doctor

A second opinion on the challenges and opportunities facing today's physicians.

Blog: Malpractice as a customer-service problem

To defend against malpractice suits, one speaker at the recent MGMA-ACMPE annual conference in San Antonio recommended, practices must maintain constant vigilance of their health information technology systems. Another speaker said lawsuits can be avoided by showing patients courtesy and respect.

They are probably both right, though the second speaker's message was more inspiring.

Ronald Sterling, an electronic health-record consultant based in Silver Spring, Md., gave a presentation titled "Malpractice Discovery in the Age of EHR" and warned his audience that he was about to address a "depressing" subject.

Sterling said the good news was that mitigation efforts in the area of malpractice discovery could best be described as "good housekeeping," and he warned against "ceding clinical control to the techno geeks."

Sterling sprinkled his talk with horror stories such as the pediatric practice whose patient immunization records were not transferred into the EHR, and his main message seemed to be: Test systems; verify data; train staff; and document what you did.

In contrast, Doug Wojcieszak started his program about error disclosure by telling the audience he hoped his talk would be one of the best they've ever heard—even though it began on a somber note: the death of his brother Jim after a Cincinnati hospital dismissed his heart murmur, gave him an ulcer drug "cocktail" and sent him home.

The next afternoon he was in the intensive-care unit. It was there the family noticed that, instead of Jim's name on the ICU monitor, it was the name of his father—who had recently undergone cardiac tests at the facility "and passed with flying colors." Wojcieszak said his dad had to show staff his driver's license before they were convinced there was a mistake.

"They wanted to argue with him about who was who," Wojcieszak recalled, adding that—after it was discovered that Jim had four blocked arteries—he died in the operating room. The surgeon told his father that "if the jerks at the hospital had done their jobs, we could have saved your boy," Wojcieszak said. "That was the last bit of honesty and candor we received."

Wojcieszak went on to found Sorry Works! The organization started as an advocacy group and now offers training on error disclosure.

"Medical malpractice is not a legal problem, it's a customer service problem," he said, explaining that "honesty and accountability" offer a better defense than silence. "It takes the anger out of the room and the litigation goes with it."

Stonewalling and dragging out the case hurts doctors and nurses who commit mistakes and doesn't let them move on, Wojcieszak said. "It's a horrible spot to put another human being in."

Beginning at the Lexington (Kentucky) Veterans Affairs Medical Center, the approach has proved that it works, and doesn't require passing new laws, he said. It does, however, require an existing groundwork of customer service and respect: "If you were a jerk up to the apology," Wojcieszak said, it won't work.

Follow Andis Robeznieks on Twitter: @MHARobeznieks.


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