Sorry Didn't Work? Great Teaching Case...
I recently gave a CME-accredited lecture on disclosure and apology to a group of physicians, and some of the docs in the room had heard my talk or had read my content before. Never mind, it's always good to review important concepts and we know more about disclosure today than we did five years ago or even a year ago. So, the talk was well-received and everything went fine, until the talk was over and a physician approached me and he was somewhat angry. The doc told me how he believed in Sorry Works! but it didn't work on a certain case, it cost him money out of his own pocket, and he should have just left the family alone like his partners did with similar complications.
Here's the story: A surgery did not go as anticipated....the physician claimed it was a well-known complication that was covered during informed consent. Nevertheless, what should have been a brief hospitalization turned into a longer, more scary experience for the patient and her family. The doc said he empathized/said sorry to the patient and family, explained everything to the patient and family, spent at least 15 to 20 minutes with them every day, and, fortunately, they were able to address the complication and eventually get the patient home in good physical condition. The doc felt he did everything right and he (the doc) felt good when the patient was able to go home. The shock for our physician came a month later when the patient showed up in his office, angrily waiving a $10,000 bill in his face, and demanding that he (the physician) pay it. The doc felt "pissed off" by the entire episode, he paid $3,000 out of his own bank account, and his insurer picked up the rest. After the surgeon gave money to the patient, she (the patient) told him she never would have sued him! The doc finished by saying that his partners had similar complications with other patients, did little to no communication with the patients/families, and never had a problem. He felt burned by the entire experience. Sorry didn't work!
What would you say to this physician? How would deal with his anger? This is a good teaching case...
I have shared this case with subsequent audiences, and received many good responses. One physician said he would have told the woman and her family before they left the hospital that since it was a known complication -- NOT an error -- there would be a bill coming. Invoices from hospitals and physicians can be upsetting even under the best circumstances, so try to prepare them and lessen the blow when a complication occurs. Several other physicians said they would try to speak to the billing department at the hospital to see if charges can be reduced in some way. Another physician said at least the patient came back to the physician with her problems, as opposed to visiting a lawyer or someone else (state regulator, member of the media, etc). A couple other docs wondered aloud what could have happened had the surgeon not stayed connected with the patient and her family! All good ideas and responses...
My reply to the upset doc was that I wouldn't have paid the bill. Again, I would empathized -- "I am sorry you are upset about the bill and the complication you experienced" -- and explained to her why she received a bill (there was no error, this was a known complication we covered during informed consent), but, that would have been it. At some point, I would have told the patient that we agree to disagree, the bill is valid, it should be paid in a timely fashion, and ended the meeting --- and documented the conversation. If the patient wants to visit a lawyer, that's fine, but you have removed all the "gotcha" factors that make cases attractive to a trial lawyer.
We don't apologize -- admit fault -- and pay money when we did NOT make a mistake. Now, I fully realize that some physicians and practices or hospitals will wave bills under certain circumstances as a business or PR move, or because they simply don't want the hassle. I get it. However, clinicians need to understand that it is OK to disagree with patients/family at the end of the disclosure process. We want you to empathize post-event and stay connected with your patients and families, but if the care was solid then that needs to be communicated to the patient/family....and that's it. Disclosure is a not open-ended invitation to circular conversations, never ending verbal beat downs, or obligations to wave bills or offer money every time a patient or family is unhappy. If informed consent is done well, and post-event reviews are conducted in a credible fashion and the care is shown to be solid, many patients and families will understand and appreciate your empathy and willingness to stay connected post-event, but for those who don't you can always agree to disagree.
Again, this is a very good teaching case to share with your colleagues as well as students. We have many more teaching cases for both acute and long-term care professionals in the Little Book of Empathy and the Sorry Works! Tool Kit Book. To order copies today, simply click on this link.