October 11, 2012

A fall off a ladder, one dislocated elbow and a fractured radius bone caused a man to suffer through multiple surgeries, paralysis, extensive physical therapy, a major infection, and over $20,000 out-of-pocket. Candor by one doctor – priceless!

A recent article in the Washington Post by Kerry O’Connell tells the man’s personal story of how his dislocated elbow turned into a medical mess.   Throughout the process O’Connell describes a series of events and conversations with his surgeons and other medical professionals that severely undermined trust with these care givers.

Unfortunately, this is not a unique event. A survey published in Health Affairs shows candor isn’t always present in many doctor-patient conversations:

  • – 20% of physicians won’t tell patients about errors because of fear of malpractice litigation
  • – 55% exaggerated or failed to tell patients something about their health because, in part, they didn’t want to upset their patients
  • – 1 in 10 physicians told patients something untrue in the past year

The doctor-patient relationship may be one of the most important of our lives in certain circumstances and is protected as confidential. “Confidential,” with its connotation of honesty and importance, suggests a certain level of trust and empathy. Yet, there is a gap between these emotional, intense conversations and the delivery on trust. Wouldn’t the outcome be better for both doctor and patient if candor is present?

O’Connor talks about a critical time on his medical journey:

It had been 11 months since I’d fallen off the ladder. Now I had a damaged elbow without its needed titanium implant, a paralyzed hand and a forever numb foot. I was seriously considering asking for my arm to be cut off when my [second] surgeon walked in. He surprised me. “Kerry,” he said, “I am so sorry for giving you this infection. I don’t know how it happened…”

He said it humbly, with sincerity. It was an unforgettable act of courage on his part. It gave me the strength to not give up hope and to consider yet another trip to the operating room.

How often are these apologies? The University of Michigan Health System has implemented an “apology” program, and it has proven worthwhile in cost savings and patient satisfaction. Earlier this year, the Massachusetts Medical Society announced a pilot program called “Disclosure, Apology and Offer” in which physicians admit mistakes, make an apology and offer to settle the issue. These programs are in stark contrast to a common “deny and defend” strategy that has been the norm among some health professionals.

Is it worrisome that candor in the medical realm had gone so awry that it had to be defined, officially stated and described in recent initiatives and programs? Or is it refreshing that a profession with so much at risk has placed such great value in being forthright?