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At ORX, Why Open Disclosure Bests Deny and Defend

Transparency with patients when surgical errors occur improves care and eases the financial burden of malpractice liability.

Published: October 12, 2017

OPEN AND HONEST Dr. Kenneth Rothfield's talk on owning up to medical mistakes was a highlight of day 1 at ORX.

As with any human endeavor, mistakes happen in surgery. But when they do, medical professionals often resort to a "culture of shame and blame," says Kenneth Rothfield, MD, speaking at the 9th Annual OR Excellence in Las Vegas. When that happens, patients and families lose faith in their caretakers, says Dr. Rothfield, who implored the audience to always be transparent when the unexpected happens.

For many physicians, the challenge with owning up to a mistake is fighting the instinct of self-preservation. Some feel that complete honesty might not be necessary, so they resort to different levels of truth, including full deception, general runaround and what Dr. Rothfield disparagingly calls "truthiness." However, he says, when patients don't get a straight answer, they lawyer up.

In fact, he says, transparency should start before a procedure begins. Physicians should openly and honestly discuss risks with patients. Informed consent forms are one matter, but taking the time to personally acknowledge all the potential issues establishes a deeper level of trust. And open discussion allows patients to make their own choices. Then, if a mistake occurs, it, too, should be openly discussed.

Dr. Rothfield suggests a 3-step process: acknowledging what happened, investigating the matter and disclosing an accurate explanation with an eye toward resolution. Mistakes, he says, need to be accounted for with transparency and, even more importantly, empathy. As Dr. Rothfield notes, "Patients don't need [doctors] to be perfect, but they need [them] to be human." A thorough apology should include not just sincerity and empathy, but also a willingness to work to prevent future mistakes. That last step is often, unfortunately, the most difficult.

Open disclosure makes fiscal sense, too, says Dr. Rothfield. Doctors who withhold information from patients put themselves at risk of fraudulent concealment. Lies increase liability. If patients' attorneys can prove intentional miscommunication, medical professionals look guilty to judges and juries. Doctors who practice transparency, however, make themselves less vulnerable.

Dr. Rothfield also urges doctors not to speculate when initially apologizing, nor to draw conclusions about what went wrong until an investigation is complete. Part of a proper, humble disclosure is letting management do its job. Openness is a culture, he says, and it takes practice. With effort and consistency, though, it can dramatically improve how doctors provide patient care.

Joe Madsen

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