My mother and I are spending the next few days in Colorado participating in the Telluride Patient Safety Roundtable & Summer Camp. This event brings together leaders in patient safety, medical residents, and a few family members of people who were victims of medical errors. It is a small group, about forty-some people. The purpose is to promote safety and disclosure in the healthcare system, with an emphasis on training the next generation of healthcare leaders.
I have three thoughts to share from yesterday.
My first thought is about the words we use to name things. I think that words reveal a great deal about people’s priorities, and words can strongly influence the mindset of those training in medical professions. So we need to think carefully about the power of words. There were two phrases used today that make me very uncomfortable.
The first phrase is “second victim”, referring to the grief, anguish, and self-doubt that healthcare providers experience when their care has caused harm to a patient. This is a very real and very serious topic. I certainly don’t want to downplay this, and I strongly believe that healthcare institutions have a responsibility to provide support for their healthcare workers when they are involved in tragedies. But I just don’t feel the term “second victim” is appropriate. The victim in the patient. In a patient-centered environment, the focus is on the patient and family. It is the patient that was harmed, and in some cases died. It is the family that has experienced an injury or death. By using the term “second victim” I feel that it pulls that focus away from the patients and suggests a provider-centered mindset. The tremendous suffering of patients and families due to medical harm needs to be fully recognized—both by the healthcare institution and the public. There is not enough attention to this issue, and I don’t want the little attention there is to be diluted.
The second phrase I object to is “frivolous lawsuit” (as I have mentioned in a previous post). This phrase came out during a discussion of the barriers to open and honest communication with patients. It believe it was intended to refer to lawsuits in which there was no negligence, but that phrase is simply the wrong thing to say. It focuses blame on the patient. It implies that the patient is at fault. The patient did a horrible thing by filing a lawsuit. But lawsuits come from unmet needs. It is the responsibility of the healthcare institution to inquire about needs and provide information about what happened during the patient’s care. So I want to suggest that very often these “frivolous lawsuits” reveal problems with the healthcare institution, not with the patient. So please, let’s find a different term to refer to lawsuits in which the hospital does not believe there was negligence.
And as soon as I got back to my hotel room and checked my email, I came across another phrase that raises my blood pressure. I am on a mailing list to be notified when the quarterly newsletter of KaMMCO (a Kansas medical malpractice insurance company) is released. I clicked the link and read about their upcoming “Loss Prevention Programs” They have scheduled programs around the state with “a mock trial loosely based on a recent KaMMCO case to offer insight into trial procedures and techniques used by plaintiff attorneys.” I realize that this is an insurance company that does not want to lose money, so they talk about “loss prevention”. But I would prefer that someone focus on preventing the loss of life (and loss of quality of life) due to preventable medical harm. I think the money thing will then take care of itself. But this phrase “loss prevention” signals some different priorities.
An alignment of goals
There was quite a bit of discussion about how residents in hospitals have difficulty prioritizing patient safety because of the environments in which they work. For example, they many be responsible for far too many patients during their shift, and they may work under an attending physician who does not want to be bothered by their concerns about a particular patient’s state.
Residents don’t want to have so many patients that they can’t take the time to provide careful, quality care to those patients, and they don’t want to work in a system where there is intimidation from those higher up in the medical hierarchy. And patients certainly don’t want to suffer the consequences of these environments. These are work environment issues and these are also patient safety issues. And as one resident suggested, it looks like the goals of residents and the goals of patient safety advocates on issues like this are closely aligned, and therefore there may be an opportunity to work together to push for change. I completely agree. And if anyone has ideas, let me know.
Benefits of disclosure
We had small group breakout sessions to discuss disclosure of harm to patients. We were to come up with barriers to disclosure, benefits of disclosure, and ideas that would help disclosure to happen. Then we all returned to the larger group to list barriers and benefits. I thought the list of barriers was quite thorough. But I started to feel uncomfortable with the list of benefits. These benefits were mostly benefits to the physician (such as the emotional benefits to the physician, patients being less likely to take legal action, and such). Some were benefits to the healthcare system and the community (the institution is more likely to learn from errors and prevent them in the future). But the list was a little weak in benefits to the patient. It did include helping to maintain trust between the provider and patient, but it was missing some obvious ones. For example, patients benefit from disclosure because their right to know what has happened to their body has been upheld. Patients benefit because they have knowledge that may help them to make future medical decisions. Patients benefit because their care was delivered with integrity. I realize these reasons didn’t make it onto the list because the group was over 90% physicians and others within the healthcare system, so a physician-centered view of benefits was sure to emerge. But I think that in the future, it would be good to think about benefits in four categories: those to the physician, the healthcare institution, the patient, and the community.