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 The research team interviewed 27 patients, 3 family members and 10
staff members at three U.S. hospitals that have established programs
to communicate with patients about medical errors and efforts to
improve safety – and offer compensation when substandard care causes
harm. In every case, patients had either accepted a malpractice
settlement or been injured too long ago to file a lawsuit.
Overall, 27 of the 30 patients and family members had received
compensation, and 18 patients continued to receive care at the
hospital where the mistake occurred, the study found.
After mistakes, patient satisfaction was highest when communications
were not adversarial and included compensation. Patients and
families also expressed a strong need to be heard and expected the
physician involved in the case to listen to their feelings about the
mistake, researchers report in JAMA Internal Medicine.
“When things go wrong in the hospital, doctors tend to be focused on
doing what they do best: conveying medical information and treating
the patient,” said senior study author Michelle Mello, a law
professor at Stanford University in California.
“They may not realize that what many patients and families need is
for them to stop talking and listen attentively to what families
have to say about how the adverse event affected them, without
redirecting the conversation to clinical issues,” Mello said by
email.
Patients and families had some surprising advice for doctors and
hospitals, Mello said.
“Things like, don’t send a social worker to disclose the adverse
event, because families see her coming and think their loved one has
died,” Mello said. “Or, even if our doctor isn’t ‘a people person’
and is terrible at breaking bad news, we want to talk to him,
because he’s the one accountable for what happened.”
Another surprise was that both victims and clinicians said it was
helpful to have plaintiffs’ attorneys join these conversations, said
lead study author Jennifer Moore, of the University of New South
Wales, Sydney, Australia.
Overall, 35 of 40 respondents thought lawyers could help, the study
found.
“Some patients reported that their attorneys helped to heal the
broken trust between them and their health provider,” Moore said by
email. “Several patients and families even described their attorneys
as ‘angels’ because they were so pleased with the process and
result.”
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Although patients and families expressed a strong desire to know
what would be done to prevent errors in the future, 24 of the 30
participants said they didn’t get information about safety
improvements, the study also found.
“I suspect that hospitals simply underestimated the importance of
providing this information back to patients,” said Dr. Anupam Jena
of Harvard Medical School and Massachusetts General Hospital in
Boston.
“There is a strong incentive for hospitals to make changes to
improve quality of care after an adverse event, not only to prevent
future similar events from occurring but also because hospitals
would look unfavorable if a second adverse outcome occurred and no
steps were initially taken to prevent that second event,” Jena, who
wasn’t involved in the study, said by email.
Being open after errors may also help avoid litigation, noted Dr.
Gary Noskin, senior vice president and chief medical officer of
Northwestern Memorial Hospital and a researcher at the Northwestern
University Feinberg School of Medicine in Chicago.
“Traditionally, hospitals follow a ‘deny and defend’ strategy
providing a paucity of information to patients,” Noskin, who wasn’t
involved in the study, said by email.
At the end of the day, the study, while small, still highlights what
may be a fairly universal need patients have after medical mistakes,
said Dr. William Sage, a professor of law and medicine at the
University of Texas at Austin who wasn’t involved in the study.
“The importance of individualized engagement and empathy is really
the take-home lesson from the study,” Sage said by email.
SOURCE: http://bit.ly/2zm1vQ7 JAMA Internal Medicine, online October
9, 2017.
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