Honesty Is Best Medicine When Errors Occur

April 29, 2003

Imagine that a newborn dies shortly after delivery. The distraught family is looking for answers and yet the doctor’s instinct may be to retreat and say little, in fear of being sued. But a new book for health care providers asserts that being honest and forthright is best, and provides a roadmap for discussing bad news with patients and families.

What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics confronts many controversies that exist in medicine today. It is time for physicians to rethink the way they talk to patients, in light of more awareness of medical errors and skyrocketing malpractice insurance rates, says co-author James R. Woods, M.D., the University of Rochester Medical Center’s Henry A. Thiede Professor and chair of the Department of Obstetrics and Gynecology.

The book grew out of a series of nationwide speaking engagements in which Woods and co-author Fay Rozovsky, J.D., M.P.H., senior vice president, Marsh National Health Care Practice, began educating doctors about the consequences of poor communication and inadequate informed-consent procedures in hospitals.

The book focuses on obstetrics, an area in which patients enter a hospital relatively healthy, expecting to have a "normal" experience and to leave with a healthy baby. If anything goes wrong, it is extremely emotional for the patient, the doctor, and other hospital caregivers. Obstetricians must know how to cope with tragedy and anger, Woods says, but the book’s advice is applicable for any area of medicine.

Reform in doctor-patient communications training is critical, Woods believes. The current practice of limiting such training to medical schools is a problem, Woods says, as young doctors don’t have the life experiences to appreciate how and why patients react as they do.

Indeed, most lawsuits stem from doctors who do not have the confidence, compassion, or skills to confront angry families and try to search for common ground, Woods says.

The books offers scenarios that make physicians uncomfortable. For example, if a patient suffers from a medical error, the family will often tell the doctor they hold him or her directly responsible. The proper response might be for the doctor to ask, "Why have you arrived at that conclusion?" The doctor’s willingness to confront and discuss the situation puts him or her in a better position to explain the actions and offer sincere apologies.

"Simply having the conversation is not an admission of guilt," Woods says. "Often, patients are so shocked at full disclosure by a doctor that they do not sue. After all, many times they are only looking for accountability, and a realization by the hospital that something in the system needs to be fixed."

What Do I Say? is published by Jossey-Bass, a division of Wiley Co., May 2003, ($35). It is Woods’ third book. In 1987 and 1997, he and co-author Jenifer L. Esposito Woods wrote two books about pregnancy loss. A sought-after speaker at professional conferences, Dr. Woods is a renowned clinician and researcher, and has published numerous journal articles on high-risk pregnancy, pregnancy loss and the effects of drug abuse on pregnancy.

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