BETTER COMMUNICATION Encourage your surgeons when dealing with adverse events to first discuss the issue with their insurance agents before disclosing the incident to the patient and her family.

When an adverse event occurs, the patient and his family want to know what happened. If a doctor or facility avoids giving an answer, or worse, lies, it is often the start of a heated medical malpractice suit. In fact, it's been shown that patients who are dissatisfied with how their provider handled an adverse event are more likely to sue than when communication about the mistake is open and honest (osmag.net/C7CtnE).

Often, though, the doctor isn't dodging questions due to maliciousness, but because of the complicated relationship between the provider or facility and its malpractice insurer. Hiding the truth about an adverse event is wrong, but until our current system changes, it's a threat you need to be aware of. Patients and families want answers after these events, and handling them in the correct way can save your facility and physicians the time and hassle of a lawsuit while cultivating a good relationship with patients.

Why this happens
It's clear that a physician should never lie, but frequently clinicians and facilities are bound by their malpractice insurance to avoid claiming any liability for medical mistakes.

Medical malpractice insurance policies often contain a "cooperation" clause requiring providers to cooperate with their insurer's efforts to defend them against a claim. A common stipulation in this clause forbids the facility or provider from admitting liability to a harmed party. If they do, it could mean the malpractice insurer walking away from the claim, leaving the provider at risk of financial and possibly professional ruin. To avoid breaking this clause, clinicians may dodge patient questions about what happened after an adverse event, commonly referred to as "deny and defend."

But this leads to major problems down the line. Patients are disgusted with the lack of explanation for why they were harmed and it can lead to a "make them pay" mentality, where they'll file a suit just to get answers. These malpractice claims end up damaging the facility's and physician's reputations, not to mention they can drag on for years and impact everything from the provider's family life to their future quality of care.

Developing a better way
The system is starting to change. Some malpractice insurers are looking at moving to an early disclosure, early intervention claims model, where they encourage facilities and providers to disclose the incident, express sympathy and then quickly move to resolve the matter. Many states have passed laws that now protect physicians who express sympathy to patients, and encourage disclosure of adverse events. This may be the only way to fix a systemic malpractice problem that has plagued the practice of medicine for many years.

But there are ways to make the process work more smoothly for everyone involved in the interim. Talk with your insurance agent or carrier to better understand your cooperation clause or any other stipulations about how you could handle communication with patients who've suffered from adverse events. If made possible in your malpractice coverage, try to follow an early disclosure, early intervention claims model, where you call your agent to discuss the issue first, and then disclose the incident to the patient and family and offer your sympathy.

Not only does this model help improve your relationship with patients and avoid a malpractice suit, but it also improves quality of care going forward. Having an early recall of events lets the medical team recognize and address the cause of the adverse event, and develop methods to avoid such cases in the future.

Be sure to also stress to surgeons and other clinicians that lying or hiding answers from patients or facility leadership about adverse events will not be tolerated. Even if what you can say to injured patients is limited by your malpractice coverage, it's never a good idea to lie or attempt to change medical records to hide the truth.

The early disclosure, early intervention claims model is simple, but it can work wonders. For example, consider this recent story: After a patient died on the table while under anesthesia, the providers immediately called their insurance agent, who pulled their insurer into the process. The provider was then able to deal with the patient's family openly and transparently. The family ended up not suing the facility and provider, and did not seek additional payment. That same family continues to visit and maintain their relationship with the same hospital and doctors today. OSM