Guest Simone Posted March 3, 2003 Report Share Posted March 3, 2003 I found alot of great news articles this week.This was my favorite of course.Being as I wholeheartedly understand how important this issue is to us Cushie's.Enjoy. I was thinking about printing it out and anonymously sending it to the dr whom I developed exogenous Cushing's from.Maybe,it makes me smile anyhow. (Feb.26) - Medical errors happen. Sometimes, patients get hurt. When they do, what they need from their doctors is much different from what they are likely to get, a new study suggests. Appearing in the Feb. 26 issue of The Journal of the American Medical Association, the study gathered 52 patients and 46 doctors into 13 focus groups. Meeting separately, they talked about what they would expect when a doctor tells a patient that he or she was hurt because of a medical error. Then the doctors and patients met together to hear each other's point of view. The findings: Patients want to know when medical errors happen. They want compassion. They want an apology. And they want to know what the doctor is going to do to make sure it won't happen again to them or to somebody else. Doctors, on the other hand, weren't sure how much patients wanted to know. They didn't want to look unprofessional by showing too much feeling. They were afraid an apology would lead to a malpractice suit. But when the two groups met together, important things happened, says study leader Thomas H. Gallagher, MD, professor of medicine and medical history and ethics at the University of Washington, Seattle. Patients learned that doctors are afraid to talk about the terrible anguish they feel over medical errors. And doctors learned that patients want lots of information -- and that more they disclose, the more their patients will trust them. "Patients feel error disclosure would increase trust," Gallagher tells WebMD. "Doctors want to be truthful, but a number of barriers exist for them. Because of fear of malpractice suits, these are difficult conversations for doctors to have. Many doctors fear that telling patients they made a mistake is a sign of incompetence. And few have had any training in having these conversations." The heart of the problem is that patients must understand that doctors are human beings. By the same token, doctors must act more like the humans they are, says researcher Victoria J. Fraser, MD. Fraser is professor of medicine at Washington University, St. Louis, where the study took place. "Medical error isn't the result of being bad, but of being human," Fraser tells WebMD. "What patients need is the most important thing. By communicating more effectively and supportively, doctors make things better and not worse. The more open and honest, caring, and compassionate a doctor is -- particularly in the setting of very devastating situations -- that will always be better than not being able to communicate and show concern and offer support. The relationship between a doctor and a patient is very important. It is not a machine. It is two people, both trying to do their best and trying to get the best outcome. If we can get healthcare back to being more personal, the way it used to be, healthcare will be better." Patients were surprised to hear how much medical errors affected the doctors who took part in the study. "There were doctors who cried when they described errors where outcomes were bad and patients had been harmed," Fraser says. "They also described inability to sleep, loss of appetite, depression, feeling they were failures, feeling like quitting, feeling they couldn't go on. Every day in a doctor's life, they have potential to harm someone. Every mistake a doctor makes affects a person's life. That is a very powerful burden. ... We have to find a way to recognize the tremendous emotional impact of the job healthcare providers do in trying to take care of very sick people and having outcomes that are not under anyone's control." Doctors must learn to deal with these issues, says John D. Banja, PhD, a clinical ethicist at the Emory University Center for Ethics in Public Policy and the Professions. But they don't learn this from traditional medical training. "When you've made a medical error, you have to answer the patient's questions as best you know, you have to swallow your pride, you have to try to get over your own psychological defense mechanisms," Banja tells WebMD. "The doctor is struggling with intense feelings of embarrassment, of incompetence, of humiliation, and of fear of being sued. When a human is in such emotional turmoil, you are trying to ward off these nasty feelings. That's why it is not unusual that doctors will blame one another, or try to rationalize the error -- they say 'This patient is going to die anyway,' or, 'It is the patient's own fault -- if he were not so fat, if she were not so sick, if they had better insurance, this wouldn't have happened.' Blame the patient -- it happens a lot. But this is a natural response for any human being. So we have to be aware of how our psychological defenses are going to impact our ability to communicate medical error." Banja stresses that doctors must be completely truthful -- including showing that they care. And there's one more big thing. "You absolutely need to apologize as well," Banja says. "It is amazing how therapeutic the apology is. It subtracts insult from injury." Yet saying "I'm sorry" scares doctors more than anything. Most feel that this sets them up for a lawsuit. Indeed, many medical schools and hospital legal staffs warn doctors against apologies. But that's really not necessary, says medical malpractice attorney J. Scott Kramer. Kramer, a partner at the Philadelphia law firm Duane Morris LLP, is former chair of the medico-legal committee of the Philadelphia Bar Association and a member of the medical malpractice task force of the Philadelphia Court of Common Pleas. "Saying 'I'm sorry' seems to me to be part of the doctoring process," Kramer tells WebMD. "A simple 'I'm sorry' could avoid a trip from the patient to a lawyer in the first place. And plaintiffs' lawyers make a big show of doctors being uncaring in cases where they have been less than forthcoming with information about a medical error. Providing information and offering empathy is very appropriate and not an indication of liability or a guilty conscience." Clearly there's a sea change that must take place in medical training. Fraser, Banja, and Gallagher say they and others are working hard to make that happen. "We need to build systems to give doctors emotional support and education and training about how to communication more effectively," Fraser says. "Maybe through those programs we can help patients see the compassion in their doctors again." SOURCES: The Journal of the American Medical Association, Feb. 26, 2003. Victoria J. Fraser, MD, professor of medicine and medical director of infection control, BJC Health System, Washington University, St. Louis. Thomas H. Gallagher, MD, professor of medicine and medical history and ethics, University of Washington, Seattle. John D. Banja, PhD, clinical ethicist, Emory Center for Ethics in Public Policy and the Professions, and associate professor of rehabilitation medicine, Emory University, Atlanta. J. Scott Kramer Duane Morris LLP, Philadelphia, former chair, medico-legal committee of the Philadelphia Bar Association; member, medical malpractice task force, Philadelphia Court of Common Pleas. ? 2003 WebMD Inc. 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