A message to doctors: Admit errors and apologize

by Andrea Gerlin
Knight Ridder Newspapers

PHILADLEPHIA - An editorial appearing in a leading medical journal today calls on doctors and hospitals to disclose their mistakes to patients and families and to apologize when they occur.

The editorial in The Annals of Internal Medicine, written by Albert Wu of Johns Hopkins University School of Medicine, makes the case that withholding information about errors is not only unethical but costly because such decisions can inspire lawsuits. Prompt and full disclosure, Wu argues, may reduce malpractice suits and legal expenses.

He urged hospitals and doctors to adopt the approach used by the VA Medical Center in Lexington, Ky. As The Inquirer reported in a four-part series about medical mistakes published in September, the center goes out of its way to tell patients and families about mistakes in every case as soon as possible, helps them file paperwork and seeks to resolve problems with fair settlements.

In a study that the editorial by Wu accompanied, the 407-bed Kentucky hospital reported that it reduced its claims payments from among the highest in a group of similar VA facilities to among the lowest. The move also saved the government legal expenses, which the study estimated at $250,000 for a single malpractice case.

"Despite following a policy that seems to be designed to maximize malpractice claims," wrote the study's authors, Steven Kraman and Ginny Hamm, "the Lexington facility's liability payments have been moderate and are comparable to those of similar facilities."

The policy "diminishes the anger and desire for revenge that often motivate patients' litigation," they wrote.

Wu called the position that the hospital took "courageous." "I am suggesting that the correct thing to do is a policy similar to that of the Lexington VA, which is one of full disclosure," he said yesterday. "It's the right thing to do. It's what you, if you were the patient, would want."

From the Fall 2000, news@vhaethics FROM THE FIELD From the Field If there is any ethics related activity you feel the Center should be aware of, please let us know by clicking here. Kansas City VA Ethics Education Lexington VA Patient Safety Initiative Kansas City VA Ethics Education The Ethics Advisory Committee (EAC) at the Kansas City VAMC is currently sponsoring two innovative educational opportunities in health care ethics. The first is a recurring series on four topics offered to all staff: (1) Framework for Ethical Decision Making; (2) Rationing Health Care; (3) How Do YOU Want to Die?; and (4) Ethical Issues at the End of Life. To maximize opportunity and convenience, the EAC presents each topic three times per year. The Kansas City VAMC Education Coordinator manages logistics and promotion. The sessions are more interactive than didactic, and participants receive continuing professional education credits. The syllabi include reading materials from the ethics literature and case studies. New cases are presented each time to keep repeat attendees interested. Chaplain George Flanagan, Co-chair of the ethics committee, facilitates the sessions. Kansas City's EAC will also host discussions of the PBS television series, "On Our Own Terms: Moyers on Dying," on September 10-13, 2000. Staff will be invited to watch each of the series' four segments at home, then attend discussion groups the next day at the medical center. Participants will receive continuing professional education credits for each discussion. Chaplains will facilitate the group discussions using materials provided by WNET. The purpose of these sessions is to heighten awareness of the bereavement needs of both patients and staff. Information about the PBS broadcast and resource materials are available at http://www.wnet.org/onourownterms. Lexington VA Patient Safety Initiative Non-maleficence (do no harm), respect, honesty, and trust are ethical building blocks of the physician-patient relationship. These principles are tested when physicians make mistakes that harm patients. In 1998 the Lexington VAMC addressed this issue by implementing a trust-based patient safety policy hospital-wide. Key features of the policy include routine, full disclosure of errors; proactive compensation for patients injured by negligence or errors; and systematic improvements in clinical processes to avoid future errors. A multi-disciplinary committee investigates incidents potentially caused by medical errors. When the committee's review reveals that a patient has been injured, the medical center does not wait for the possibility of a lawsuit before taking action. Instead, the patient is promptly contacted, notified of the findings, advised about options, and assisted in applying for compensation. Since its inception, the medical center has witnessed a steady increase in provider self-reporting - suggesting that a trust-based patient safety program can work. Lexington's policy was recently highlighted in an article entitled "Risk Management: Extreme Honesty May Be the Best Policy," which appeared in Annals of Internal Medicine1. The article was written by Steve S. Kraman, M.D., (the facility's Chief of Staff) and Ginny Hamm, J.D., (Legal Counsel and member of VHA's National Ethics Committee). 1 In an accompanying editorial, Albert Wu, M.D., lauded Lexington's policy and strongly encouraged its adoption by other medical facilities throughout the country. 2 He described the policy as "a rare solution that is both ethically correct and cost-effective." To read the article and editorial in Annals of Internal Medicine go to http://www.annals.org/issues/v131n12/full/199912210-00010.html The Lexington program has been covered widely in the lay press. To read more go to Philadelphia Inquirer http://health.philly.com/specials/mistakes/lex14.asp Seattle Times http://seattletimes.nwsource.com/news/health-science/html98/errr_19991221.html Lexington, KY Herald Leader http://www.kentuckyconnect.com/heraldleader/news/092199/localdocs/21med-hospLEX-3.htm 1. Kraman SS and Hamm G. Risk management: extreme honesty may be the best policy. Ann Int Med 1999.131;963-967. 2. Wu AW. Handling hospital errors: is disclosure the best defense? Ann Int Med 1999. 131:970-972.   Next Article / Fall 2000 Table of Contents / news@vhaethics Home Page VA Home Page / VHA Home Page / VHA Programs / Search / Site Map / Facilities Locator / Disclaimer / Privacy & Security Statement / Accessibility Notice / Freedom of Information Act / Contact the VA / Contact the Webmaster