Need to blow the whistle? A disclosure policy will help
Full disclosure can eliminate finger-pointing
For a doctor, telling a patient or patient's family that a medical error has happened in the course of his or her care is hard enough. But what if the error was committed by another provider?
As one physician wrote in the Journal of the American Medical Association, "Whistleblowing is not an appealing activity."1 The literature reveals numerous approaches and rationales for handling the disclosure — or not — of errors committed by others: Commonly suggested options include confronting the errant physician and asking that he or she make the disclosure; arranging a meeting involving yourself, the other physician, and the patient; telling the patient about the mistake without consulting the physician who committed the error; and, least preferably, saying nothing. Each has its drawbacks, authors have concluded.
According to Doug Wojcieszak, founder of the Glen Carbon, IL-based Sorry Works! Coalition, whistleblowers aren't necessary when a hospital implements a policy of full disclosure. Sorry Works! is an organization of doctors, lawyers, insurers, and patient advocates that is dedicated to promoting full disclosure and apologies for medical errors as a "middle-ground solution" for medical liability.
Under the Sorry Works! protocol, if a standard of care was not met (as shown by a root-cause analysis) in a bad outcome or adverse event, the providers (and their insurer) should apologize to the patient/family, admit fault, provide an explanation of what happened and how the hospital will ensure that the error is not repeated, and offer compensation. Five states now have mandatory disclosure laws on their books, and numerous health care systems (including the Veterans Administration) have implemented full disclosure and apology policies.
The result, they say, is better patient and physician satisfaction with outcomes, and reduced financial costs related to malpractice lawsuits.
Whistleblowing a sign disclosure is needed
A survey published in 2006 in the Archives of Internal Medicine reveals that almost every doctor polled (98%) supports disclosing major medical errors to patients, and 66% agree that disclosing serious errors reduces malpractice risks.2 The American Medical Association's code of ethics requires disclosure of errors.
Whistleblowing — or health care providers feeling the need to disclose errors by others — is one sign that a disclosure policy might be needed, says Wojcieszak.
"It goes on a lot in institutions where there's not disclosure and apology — where everyone knows there's been a mistake, and that it's being covered up, until someone with a conscience gets with the family and lets them know that something has gone wrong," he explains.
That scenario, Wojcieszak insists, benefits no one involved.
"On the other hand, if you have a disclosure and apology policy that's rolled out throughout the entire institution — one strong voice for the whole institution — you lessen the chance for finger pointing, or 'jousting,' as someone referred to it recently," he explains.
When a hospital implements a disclosure policy, "everyone knows when an error occurs how to follow through with reporting it."
Not that disclosure is a universally accepted idea, Wojcieszak acknowledges.
"Say you have Doctor X, an old-time doctor taught from the minute he first put on his white coat that you never admit fault, you never apologize. He thinks this disclosure thing is a fad," says Wojcieszak. "Then, an incident happens [involving one of his patients] — what happens?"
If the doctor doesn't believe the patient or family should be told of the error, there are channels that allow the disclosure process to simply bypass that doctor, with the hospital going forward with disclosing the error and making apologies.
"The good thing about medical errors is that it's usually not just one person who's involved," Wojcieszak points out. "And the good thing about a disclosure program is that it gets everything back to the risk management department, to people who are trained on what to do with the information."
The disclosure model works most easily at self-insured hospitals, where everyone is insured and employed by the same entity.
"You can have some tricky circumstances where one doctor is insured by his own [outside] insurance company, but the hospital will have had a conversation with this insurance carrier long before any incidents come up," he says. "The hospital talks with the insurer, and the insurer helps bring the doctor on board."
Finally, a disclosure policy not only assures that patients are informed, but that they are informed accurately and fully.
"It does away with errant disclosures — where, for example, a resident thinks he did something that caused a patient to die, and tells the family he accidentally killed the patient," he says. "It turns out he didn't, but it's not helpful that he said he did. That's how you get nonmeritorious claims filed. Full disclosure and apology [policies] provide a channel for reasonable, well-thought-out disclosures."
References
- Fost N. Ethical issues in whistleblowing. JAMA 2001; 286:1,079.
- Gallagher TH, Garbutt JM, Waterman AD, et al. Choosing your words carefully: How physicians would disclose harmful medical errors to patients. Arch Intern Med 2006; 166:1,585-1,593.
Sources
For more information, contact:
- Doug Wojcieszak, spokesman, Sorry Works! Coalition. P.O. Box 531, Glen Carbon, IL 62034. Phone: (618) 559-8168. E-mail: [email protected]. Web site: www.sorryworks.net.
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