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Holiday Airline Troubles Are Reminiscent Of Health Care Experiences

One of the hot phrases in health care these days is “patient-centered,” as in “patient-centered hospitals,” “patient-centered practices,” and “patient-centered medicine.” For all of you out there working on creating such “patient-centered” systems, let me provide a bit of advice based on a recent experience my family and I had with Delta Airlines. For if you substitute the word “customer” for “patient,” you get what every business, whether in health care or not, should be focused on — the person receiving, nay, purchasing, their services. The ones you hope will return, again and again.

I’m actually writing this as I sit in the lobby of a hotel in Park City, Utah. It is a gorgeous day outside, crisp and cold, just perfect for the skiing my family had in mind when we booked this trip; it’s a short trip– just 3 days on the slopes before we head home — so every minute counts. Unfortunately, despite plenty of time sitting in airports yesterday (i.e., no tight connection), only 2 out of our 6 pieces of luggage made it here. Fortunately, one of those was the suitcase filled with skiing togs. Unfortunately, one of the missing pieces was my son’s new snowboard, also filled with all of his ski togs. So while my boys are out on the slopes (the snowboard kid wearing my ski clothes), I’m sitting in the lodge awaiting our luggage. It is nearly noon — half of the day gone, one-sixth, possibly one-third, of our vacation gone–and I have not yet set foot on the slopes. Sure, I could head over and buy all-new ski stuff. . . . but that isn’t the point.

The point is how this was handled. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

Medical Apology Policies: A First Step In Medical Malpractice Reform?

An often overlooked tool in health care providers’ struggle with the malpractice crisis is the medical apology.  Two thirds of the states provide some form of protection for the medical apology (i.e., a simple apology is not admissible in court as an admission of culpability), and settlements reached post-apology are almost invariably lower than they would be otherwise.  (In the current environment, articles on medical apologies are popping up everywhere … even in the NY Times business section.)

It is important to note that an effective apology policy does not stop with the simple apology — I’m sorry that this happened to you — but must include a commitment to conduct a root cause analysis, to communicate the results to the patient and/or patient’s family, to implement systems improvements based on the results of the root cause analysis, and to offer a specific apology once the analysis is complete, and an offer of monetary compensation if the provider or its systems were at fault.  Of course, it’s easier to describe these steps than to actually carry them out. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

When Should A Doctor Apologize?

The movement for physicians to say “I’m sorry” when things go wrong in patient care has been under debate for the past few years. In the past, physicians were advised to never admit to a problem or to apologize for clinical errors with the thought that it would lead to more lawsuits. Saying “I’m sorry” might be taken by a lawyer as an admission of guilt and malpractice. Attorneys advised, “Say nothing” but that left patients with unanswered questions and often the feeling that the doctor just didn’t care.

Numerous studies have shown that patients want physicians to disclose harmful errors and they want information about what happened, why it happened and if something has been done to keep it from happening again. There has been a gap between what patients want and what actually occurs. Read more »

*This blog post was originally published at EverythingHealth*

A Heartfelt Physician Apology

A recent oft-cited study showed that doctors who who apologized for mistakes were less likely to be sued.  My initial reaction to that is to file it under “duh.”

But then I was greeted with a note lying on my desk.

Dr. Rob:

First, I want to tell you that for the majority of the many years my family has been patients of your practice, I believe we received excellent care and you always had our best interests in mind.  Further, we appreciate all that you and your staff have done for us.

However, it is with great regret that I find myself in the position of writing to you with a problem I see as pervasive in your practice…

Ugh.  This is not the way to start my day.

The letter went on to describe a problem with communication of a concern the patient had about a medical problem that was very worrisome to her.  It didn’t point the finger of blame at my nurse, nor any one else in the office.  It wasn’t at all angry in its tone to me.  It simply expressed the disappointment of a patient who felt let-down by her physician.

The letter ended with:

I look forward to speaking with you about this issue early in the week of July 20.

Thank you in advance for your attention to this matter.

I put off calling her until the end of the day.  I knew she would be reasonable overall, but beyond the fact that I hate calling people on the phone at all, I hate calling when I know I have to apologize.  The problem in this case was not with my staff or with confusion in the office.  The problem was with a physician who simply dropped the ball and did not follow-up as promised.

I finally called:


First let me say thank you for the letter you sent.  I mean that sincerely.  I would much rather hear about problems in our office than to simply having people get angry and leave.  This is something I needed to hear.

Second, let me say that the blame is 100% mine.  I really wasn’t worried about the problem and so I honestly just let it slip my mind.  I did tell you I’d contact you and would send you to a specialist if things weren’t clear after the tests I ordered.  I’m sorry about that.

I went on to discuss the situation and that I didn’t think anything was serious at all.  She still wanted to go ahead with the consultant because of some stuff she had heard about the condition.  I told her that I have no problem with that, as I see my job as one of giving my advice and perspective; but not as making the final decisions.  The most important thing is that her worries are addressed and that she feels comfortable that everything is OK.  If it takes a consultant to do that, then I have absolutely no problem with that.

I also explained that communication in a medical office is very difficult – and has gotten much harder as we have gotten busier.  It is our plan to eventually have communication by e-mail, but that is not ready for prime-time. This is not an excuse, I told her, but an explanation and a promise that I do see the problem and we are doing something about it.

As expected, she was gracious about the situation and was thankful for the apology.  I didn’t do it to avoid lawsuit or to protect myself.  I like this family and didn’t want to lose them as patients.  Beyond that, though, I owed her an apology.  I had let her down.  I hadn’t done what I promised I would do.  She had been kind enough to send me the letter and deserved a quick resolution to the situation.

I still hated picking up the phone, though.  It isn’t easy to admit fault, no matter how accepting you know the other person will be.

As obvious as it seems that apologizing will prevent lawsuit, it is a hard thing to do.

But I am glad I did.

*This blog post was originally published at Musings of a Distractible Mind*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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