By Betsy M. Cohen (Certified and Licensed Rehabilitation Counselor)
I have been a rehabilitation specialist and case manager working with patients who have neurological and neuropsychiatric impairments for thirty years. About three years ago, my life took an unanticipated detour when I was perforated during a baseline colonoscopy. The doctor explained that she was running late and didn’t follow standard procedure at the time I was perforated. All of my experience as a case manger and patient advocate could not prevent this error or the others that followed; ignored symptoms of an infection that became a large abscess and nerve damage during a procedure to drain the abscess.
Although my health, body and life were forever altered by the accidents that occurred during this initial hospitalization and a re-admission, I was able to use my background and skills to identify medical, rehabilitation and complimentary health services and find a way to flourish. Now my focus is on preventing and repairing these situations with a program that involves both patients and doctors, #ACFC, Apologize, Communicate, Forgive and Change.
Apologize
It may feel humbling and there may be occasions when the outcome or error was not preventable. Apologize does not mean falling on a sword and admitting to things that would make the hospital lawyers apoplectic. Before everyone swoops in and lawyers up, be a human being, a professional and do the right thing and speak rather than be silent. Silence suggests secrets and does not lend itself to transparency. Silence is cold; it does not comfort. Patients need comfort. They also need security and trust. What do you do when the doctor you trusted made a mistake? How do you trust them again? Patients need for safety- physical and emotional, should be the initial priority. Statements that acknowledge the patient’s experience, offer compassion, yet admit no guilt could be relayed, such as: I am sorry that you have this complication. I am sorry that this unfortunate risk of the procedure happened to you. It doesn’t happen often, but it can occur. This measured response still allows for the hospital investigation to proceed and explore the details of how and why the error occurred without alienating the patient or undermining their care.
Communication
Hippocrates knew what mattered most when he quipped: “It’s far more important to know what person the disease has than what disease the person has.”
Long before there is a medical procedure that could potentially involve an accident, physicians are establishing rapport with a new patient, listening to their concerns, gathering their medical history and educating them on conditions they may have, as well as recommending preventative care. This is the foundation of the doctor-patient relationship that is too often disrupted today by the electronic medical record, documentation requirements, insurers or administrators who want to dictate how healthcare should be delivered. Building trust through real communication with your patients, listening and talking through their personal and health issues makes you a doctor who truly practices patent centered care. Talk to your patient if there is an error. It is more difficult to litigate against an ally. Don’t allow fear to determine what kind of practitioner you choose to become in your evolution as a physician.
Forgiveness
This process takes time for doctors and patients involved in the aftermath of medical errors, but I would suggest that the initial responses of the doctors, healthcare professionals and the hospital involved have a good deal to do with outcome. In my situation, none of the three physicians involved in my care apologized nor did they own the multiple errors that necessitated additional procedures. As the patient, I felt abandoned and trapped in a hospital where I seemed like the only person committed to my full recovery. When the GI surgeon told me – “I can’t wait until you are no longer my patient. So many complications” – I was shocked that a doctor thought that blaming the patient for being ill regardless of the etiology of the condition seemed like a wise decision. Eventually, this complex journey is very much an individual one, and for me it had more to do with how I chose to live my life than it did about getting caught in a cycle of anger regarding what had occurred. Choosing to forgive and not to litigate meant freeing myself up of the much needed physical, emotional and spiritual energy to continue on my path to healing. Determined to use this experience to expand my message and role as a patient advocate and facilitator of improved doctor-patient communication has allowed me to create something positive from a very unfortunate series of events.
Change
To make effective change, we need to learn. Learn that there are different perspectives for both doctor and patient, that each is valid and important and gleaning an understanding from both experiences strengthens the patient-doctor relationship and the possibility of improving patient care. Learn that hospitals must lead and prioritize patient safety. They must also recognize the importance of the patient’s voice and develop ways to integrate patients’ experiences into their improvement plans, however uncomfortable an experience it may be to talk about what hasn’t worked previously. An organization that doesn’t take customer satisfaction and feedback seriously and learn to incorporate recommendations from their user group does so at its own peril. It isn’t enough to attend a seminar on patient safety and continue to practice business as usual. It isn’t enough to say we are now very patient centered in our care without actually including any changes in care delivery that patients have identified as critical. And the IRB does not exist to protect and defend or ignore facts because a senior physician was involved. The IRB has a responsibility to the patients and their fellow physicians. Doctors are – – — human. They will make mistakes. Learn can’t flow into change if professionals are shamed or ostracized in the process.
Finally, in today’s healthcare system, it is not easy to be either a patient or a physician. Mutual respect, trust and conversation around these issues would help to buoy the doctor-patient relationship, improve the healthcare delivery system and patient safety. In the words of Martin Bromiley, “that others may learn, so others may live”.
Betsy M. Cohen is a Certified and Licensed Rehabilitation Counselor, C.R.C., L.R.C., a Certified Case Manager, C.C.M., and an American Board Certified Senior Disability Analyst, A.B.D.A. She has been a practicing counselor specializing in the treatment of individuals who are affected by neurological and neuropsychiatric disabilities, chronic illness, as well as catastrophic conditions for the past thirty years. A sought after speaker on issues relating to adjustment to disability, the vocational rehabilitation process and navigating the healthcare system, Betsy’s professional energy is focused on patient advocacy and facilitating improved communication and satisfaction between consumers and healthcare providers.