ON MEDICAL MALPRACTICE
We disagree with Dr. Darshak Sanghavi that “there is no appetite in the medical community to come clean preemptively” about medical errors and that no major reforms “are truly proactive” (“Why Is It So Hard for Doctors to Apologize?” January 27). The establishment of the Communications, Apology and Resolution (CARe) program in 2012, and the support it has among hospitals, physicians, attorneys, insurers, and patients, is testimony to a desire to fix a broken medical liability system and improve patient safety. The result of years of effort by our two organizations, CARe offers what patients who have experienced harm tell us they want: full disclosure of what happened and why, what will be done to prevent a recurrence, and for those events deemed avoidable, a sincere apology and offer of compensation. Six hospitals are now conducting pilot programs, and the Massachusetts Alliance for Communication and Resolution following Medical Injury (macrmi.info) has been established to resolve cases quickly, better report errors, and reduce defensive medicine. It promotes transparency, honesty, fairness, and greater safety. Patients should know that, with regard to medical errors, physicians are not only listening but are also taking action.
Dr. Alan Woodward / Chairman, Massachusetts Medical Society Committee on Professional Liability
Dr. Kenneth Sands / Senior Vice President, Health Care Quality, Beth Israel Deaconess Medical Center
We are glad to see the medical community and insurance industry recognize the vital role medical negligence cases have played in improving patient safety. Recent estimates suggest that medical errors could cost close to 200,000 lives per year. Yet as Dr. Sanghavi notes, the medical profession often sweeps rule violations under the rug. Medical negligence cases are often the only way to uncover violations. The next step for Massachusetts is the elimination of secret peer review. This guarded internal investigation, designed to foster confidential communication between health care providers, prevents learning from mistakes. The patients and their attorneys are shut out from learning what was discussed in these meetings — a shocking revelation to a person whose own body is the subject of the discussions. Saying “I’m sorry” is a good start, but as we teach our children, saying it is not enough. With hope, we will see a change in the health care industry, but the public should never forget the tremendous efforts of patients who, through our civil justice system, bring about safer medical care for all of us.
Timothy C. Kelleher III / President, Massachusetts Academy of Trial Attorneys
Dr. Sanghavi’s article does not fully or fairly capture the reasons and efforts I make when I appear in court on behalf of a client. When I try a case, it is completely about seeking the truth, and it is not a game. Our firm’s clients come to us, as did Danielle Bellerose, wanting answers and accountability. They have often received no answers or misleading ones from their medical providers, and they come to us for an honest assessment of the facts and true answers. They ask us to present their case to a jury as their advocates, which is what our firm seeks to do.
William Thompson / Lubin & Meyer
After 20 years, I am still haunted by the memory of my then 5-year-old son sobbing, saying that he didn’t want an operation. He had been hospitalized for four days with a very high fever and his urine specimen showed massive infection. A urologist decided that the specimen was contaminated and that the problem was really a ruptured appendix. Emergency surgery was performed for, as you may have figured, a perfectly normal appendix. My son later required more emergency surgery as a result of the appendectomy. He had a very difficult, prolonged recovery. If the urologist had just once owned up to his mistake and apologized, it would have gone a long way toward alleviating the anger I still feel. I hope that more physicians will learn that openness and honesty can go a long way toward resolving these issues.
Roberta Clark / Bradford
My husband, a radiologist, remembered details of all his classes in medical school, but there was one glaring omission: He and his classmates were never taught when or how they were supposed to say “I’m sorry.” In his practice, he worried constantly that he might have missed the tiniest detail. There was always a trip back to the office on weekends to check a film or ask a colleague for a second opinion. We wished for the same diligence and integrity when he was diagnosed with a brain tumor. He blindly thought that the doctors he respected would care as much about their patients as he had cared about his own. It was disheartening to realize that the medical staff treating him did not. One error after another was made from the original diagnosis to his final discharge — a day he was coldly told there was good news and bad news. The good news was the brain tumor was in remission, the bad news was he would die in six months from esophageal cancer. He was already stage 4; they missed the lesion on the original CT scan. Maybe this could have all been avoided. Maybe if they had offered a course in medical schools on how to listen to your patient and their relatives, my husband would have suffered less and enjoyed more years with his family and friends. Maybe, just maybe, I would not be as angry at a system that can demonstrate indifference when I had lived with a man who honored his profession with caring and compassion.
Jane Newman / Longmeadow
As a nurse working in an academic medical center, I sympathize with all involved in errors. No one escapes these incidents without scars. Open communication is the first step, but a serious examination of the role of discipline, reduced staffing, malpractice, and increased patient assignments must also be investigated. Creating safe environments will require all players to focus on best practices, honesty, and a healthy dose of forgiveness.
Suzannah Damaa / Medford
Is it possible that patients and doctors share equal responsibility for having put too much faith in our imperfect medical system? Eight years ago, I sat across from a surgeon as he informed me that my stage 0 breast cancer was the best kind to have because he could “cure me.” I thought it was an arrogant and bold assessment, but wanted very much to believe him. Today I live with brain and bone cancer. I have learned much since then — most of all that I need to trust myself as the expert on my body. No malpractice lawsuit, and the possibility of subsequent “award,” is going to cure my cancer. However, leaving aside the anger and disappointment will put my body, mind, and spirit in the best place for healing.
Anne M. Porcella / Needham