Never ruin an apology with an excuse – Ben Franklin
Medical malpractice is not something we like to think about. For my entire career, even though I worked for corporations and individual entities, I have carried my own malpractice insurance. Fortunately, I’ve never had to use it.
Some malpractice cases in the nation are well-known, including when comedian Dana Carvey had a cardiac bypass on the wrong coronary artery. There is a well-known case of an OB-GYN who artificially inseminated many of his patients with his own sperm (watch Our Father on Netflix for the story.) There is Christopher Duntsch, who performed spinal surgery and killed or crippled too many of his patients to mention (check out Dr. Death on Peacock.)
These stories are compelling because they’re outrageous. Most of the lawsuits we see are less outrageous but are still devastating. In the U.S., nearly 30% of all malpractice cases are related to treatment, and only 5% are related to medication errors. Yet RaDonda Vaught was recently convicted of criminal negligent homicide and gross neglect for providing the wrong medication. We make mistakes. How do we avoid the damaging effects on our residents and the possibility of bankruptcy-threatening lawsuits against our facilities?
Nationally, 20,000 malpractice cases come to court every year. Forty-one percent of patients believe their doctor gave them the wrong treatment, including diagnostic, surgical and medication errors. Are they wrong? Overreacting? Maybe not. A 2016 Johns Hopkins study even rates medical errors as the third-leading cause of death in the U.S.
What’s the answer? Easy, don’t make mistakes. How realistic is that? Not very.
I had a recently-discharged resident from our skilled nursing facility who was threatening a lawsuit because she thought her care with us was poor and contributed to further health problems. We asked for a meeting with her and her family to discuss her concerns. She had the misfortune to be admitted to our SNF just before midnight on a Friday. I don’t have to explain the challenges that brings.
She complained about a number of things that didn’t have to happen: long call-light wait time, didn’t get out of bed until Sunday and only after her family demanded it, didn’t get a shower until Monday, etc. All these things are bad and shouldn’t have happened, but staffing continues to bedevil us. My staff was exhausted from a very terrible week, and because her orders included PT/OT/ST, I came in on Saturday morning and evaluated and treated her myself. I remembered her, and she remembered me.
I began our meeting by apologizing. She was right about so many of her issues, and no amount of “we were short-staffed-it was the weekend-you had a new nurse” was going to right our wrongness. She was right. We made mistakes. And I told her that. I told her that this should never have happened to her, and I couldn’t apologize enough. She was surprised and somewhat speechless. She thanked me for my candor and for coming in on that first Saturday to see her. The talk of litigation ended in that meeting.
It is fundamentally and ethically correct for providers and practitioners to apologize for mistakes. According to The Journal of the American Academy of Psychiatry and Law:
Apologies are an integral part of human communication and can repair damaged relationships. Within the medical system, apologies remain controversial. Physicians often wish to apologize to patients harmed by medical errors, but they may not disclose errors to patients and their families because of the concern that disclosing errors could increase the likelihood of a malpractice claim. Yet physicians who apologize to patients may instead mitigate many of the communication problems known to prompt patients to pursue legal action. This idea has prompted many state governments to pass apology laws, legislation that aims to reduce rates of malpractice by encouraging physicians to apologize.
We are all human, and we all make mistakes. My mantra has always been, “Catch mistakes early, don’t make them twice.” We rely on our expertise and willingness to listen to prevent all but the very tiniest errors, and we certainly don’t want our patients to suffer because of that. But when faced with an angry resident, or angry family, try opening with empathy and an apology before defending the indefensible. We can always do better.
Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
