After medical error, apology goes a long way

Science Daily
Originally posted October 2, 2017

Summary: Discussing hospital errors with patients leads to better patient safety without spurring a barrage of malpractice claims, new research shows.

In patient injury cases, revealing facts, offering apology does not lead to increase in lawsuits, study finds

Sometimes a straightforward explanation and an apology for what went wrong in the hospital goes a long way toward preventing medical malpractice litigation and improving patient safety.

That's what Michelle Mello, JD, PhD, and her colleagues found in a study to be published Oct. 2 in Health Affairs.

Mello, a professor of health research and policy and of law at Stanford University, is the lead author of the study. The senior author is Kenneth Sands, former senior vice president at Beth Israel Deaconess Medical Center.

Medical injuries are a leading cause of death in the United States. The lawsuits they spawn are also a major concern for physicians and health care facilities. So, hospital risk managers and liability insurers are experimenting with new approaches to resolving these disputes that channel them away from litigation.

The focus is on meeting patients' needs without requiring them to sue. Hospitals disclose accidents to patients, investigate and explain why they occurred, apologize and, in cases in which the harm was due to a medical error, offer compensation and reassurance that steps will be taken to keep it from happening again.

The article is here.

The target article is here.

Tell it to me straight, doctor: why openness from health experts is vital

Robin Bisson
The Guardian
Originally published August 3, 2017

Here is an excerpt:

It is impossible to overstate the importance of public belief that the medical profession acts in the interests of patients. Any suggestions that public health experts are not being completely open looks at best paternalistic and at worst plays into the hands of those, such as the anti-vaccination lobby, who have warped views about the medical establishment.

So when it comes out that public health messages such as “complete the course” aren’t backed up by evidence, it adds colour to the picture of a paternalistic medical establishment and risks undermining public trust.

Simple public health messages – wear sunscreen, eat five portions of fruit and veg a day – undoubtedly have positive effects on everyone’s health. But people are also capable of understanding nuance and the shifting sands of new evidence. The best way to guarantee people keep trusting experts is for experts to put their trust in people.

The article is here.

Preventing Conflicts of Interest of NFL Team Physicians

Mark A. Rothstein

The Hastings Center Report

Originally posted November 21, 2016

Abstract

At least since the time of Hippocrates, the physician-patient relationship has been the paradigmatic ethical arrangement for the provision of medical care. Yet, a physician-patient relationship does not exist in every professional interaction involving physicians and individuals they examine or treat. There are several “third-party” relationships, mostly arising where the individual is not a patient and is merely being examined rather than treated, the individual does not select or pay the physician, and the physician's services are provided for the benefit of another party. Physicians who treat NFL players have a physician-patient relationship, but physicians who merely examine players to determine their health status have a third-party relationship. As described by Glenn Cohen et al., the problem is that typical NFL team doctors perform both functions, which leads to entrenched conflicts of interest. Although there are often disputes about treatment, the main point of contention between players and team physicians is the evaluation of injuries and the reporting of players’ health status to coaches and other team personnel. Cohen et al. present several thoughtful recommendations that deserve serious consideration. Rather than focusing on their specific recommendations, however, I would like to explain the rationale for two essential reform principles: the need to sever the responsibilities of treatment and evaluation by team physicians and the need to limit the amount of player medical information disclosed to teams.

The commentary is here.

When Students Become Patients, Privacy Suffers

By Charles Ornstein
ProPublica
Originally published October 23, 2015

Here is an excerpt:

Yale Health’s website informs parents that they cannot access their child’s health information without a signed written consent form. Andrea said she does not recall signing that document. When she recently asked to see any such form, she said, she was told by the counseling center’s chief that there was none. “Most of what happened while I was in the hospital happened without my knowing it,” she said. “I got an update every day or two about where my life was going.”

Andrea’s case is a vivid demonstration of how weaknesses in state and federal laws — and the often-conflicting motives of students, parents, and college officials — have left patient privacy vulnerable when students receive medical treatment on campus.

Universities walk a fine line when providing that treatment or mental-health services to students. If campus officials don’t know what’s going on or disclose too little, they risk being blamed if a student harms himself, herself, or others. If they pry too deeply, they may be accused of invading privacy, thereby discouraging students from seeking treatment.

The entire article is here.

How is the doctor-patient relationship changing? It’s going electronic.

By Suzanne Allard Levingston
The Washington Post
Originally posted April 27, 2015

Here are two excerpts:

Almost three-quarters of American adults use the Internet to search online for health information each year, according to the Pew Research Center. While patients are digging through new information, so are doctors. A “tsunami of knowledge” from hundreds of journals pours over doctors, says Jack Cochran, executive director of the Permanente Federation.

All this information changes the culture. “Doctors say they’re taught to know things that others don’t,” said Dave deBronkart, a cancer survivor and advocate for patient engagement. Today, thanks to online searches and communities, a patient may know about advances before a doctor does.

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Not only should you read your electronic health record, you should check for errors. “Most people’s records contain mistakes,” deBronkart said. His 2009 blog about mistakes in his Google Health record led to a front-page story in the Boston Globe and a career as an advocate known as e-Patient Dave. (Google Health, a free service intended to help consumers pull together medical and wellness information, was discontinued in 2013 because it failed to generate broad interest.)

The entire article is here.

'Protecting' Psychiatric Medical Records Puts Patients At Risk Of Hospitalization

Medical News Today
Originally published January 6, 2013

Medical centers that elect to keep psychiatric files private and separate from the rest of a person's medical record may be doing their patients a disservice, a Johns Hopkins study concludes.

In a survey of psychiatry departments at 18 of the top American hospitals as ranked by U.S. News & World Report's Best Hospitals in 2007, a Johns Hopkins team learned that fewer than half of the hospitals had all inpatient psychiatric records in their electronic medical record systems and that fewer than 25 percent gave non-psychiatrists full access to those records.

Strikingly, the researchers say, psychiatric patients were 40 percent less likely to be readmitted to the hospital within the first month after discharge in institutions that provided full access to those medical records.

"The big elephant in the room is the stigma," says Adam I. Kaplin, M.D., Ph.D., an assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine and leader of the study published online in the International Journal of Medical Informatics. "But there are unintended consequences of trying to protect the medical records of psychiatric patients. When you protect psychiatric patients in this way, you're protecting them from getting better care. We're not helping anyone by not treating these diseases as we would other types of maladies. In fact, we're hurting our patients by not giving their medical doctors the full picture of their health."

The entire story is here.