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Ethical
Invitations to Physicians
Individually and as a profession,
you know better than anyone the areas in which physicians need
to take responsibility for changes to improve health partnerships
and patient wellbeing. I challenge you, individually, as a profession,
and as specialties within medicine, to create more ethical health
partnerships with both patients and with colleagues.
1. Help educate patients about issues
affecting you and them:
Every physician's office
should have brochures or flyers about current issues impacting
our healthcare and your ability to provide it. We need you to
help educate us so we can help you help us! We know far less
than what you think and subsequently feel helpless. We are not.
Imagine what could happen if only 10% of every physician's patients
became educated and committed to action!
a) Call upon the AMA and other specialty
associatings to coordinate the creation of professional materials
that every physician can, and would want to, put out in their
office to educate patients.
I recently read the AMA packet
for physicians to use on malpractice. It was a turnoff to me
because of blaming lawyers and blaming it solely on frivolous
lawsuits. It's an insult to patients who know that while frivolous
lawsuits may be part of the problem, it is not the whole problem.
Also physicians are turned off by it and will not put it out.
They don't want materials that 'point the finger' .
b) Encourage all physicians to use
newly created materials in their waiting rooms.
Your offices are one of the
best places for us to get our education about health policy.
Tell us how it affects you, how it affects us, and how it affects
our relationship as doctor and patient.
2. Invitation and Challenge to Improve
Patient Safety:
Patient safety should be
the first area addressed because it protects patients and protects
physicians. While definite improvement is being made, there is
a lot more that could be done. Anesthesiologists have led the
way in making a specialty-wide commitment to improving patient
safety and have created very positive results. Each specialty
can best address its own procedures and potentials for error.
a)
Preventing Errors:
Within six months of receiving
this challenge and invitation, I would like each national specialty
association, in collaboration with its members, to identify the
top 3 most common serious errors that occur in that specialty.
The errors may be due to physician, procedural, equipment, or
systemic error.
Create a committee for each error
in order to develop plans and procedures to eliminate that error.
The committee would receive suggestions and information from
the association membership to help develop the plan. Develop
a timeline for information and implementing actions that will
lead to the elimination of the error.
Post all errors identified, committee
information (including contact information), plans and progress
on the association website, available not only to the membership,
but also to patients and other specialties. (I would be happy
to put a link to your site from this one so that your work can
inspire others!)
Part II:
After the first year of plan implementation, I challenge you
(as specialty groups) to identify at the beginning of each calendar
year the most common serious physician or systemic error in specific
common procedures or treatments in your speciality and develop
plans for reducing that error.
b) Professional Monitoring and Intervention
of Physicians Who Provide Below Average Care:
The majority of physicians
are caring, competent and committed to high standards of care
and safety for their patients. But there are some that repeatedly
perform at a substandard level. It is the duty of the medical
profession and it's regulatory boards to protect patients.
Create a committee with physicians
and members of the state medical regulatory board to identify
3 ways both physicians and the board can better protect patients
from physicians who repeatedly practice at a substandard level
that puts patients at risks. Create clear standards to identify
those physicians and create appropriate phases of intervention
. . . whether that be supervision, additional training, counseling,
or discipline. While physicians need to be protected from unfair
blame, firing or loss of privileges, patients need to be protected
when a physician regularly demonstrates inadequacy or disregard
for patient protection and quality care.
This should be accomplished within
one year from the date of the formation of the committee and
should have a method for physicians and others who are not part
of the committee to provide input and suggestions.
Make these plans available to
the public for information and feedback on regulatory websites.
Provide leadership to assist
hospitals to do the same.
3. Invitation to Improve Communication:
Studies have shown that improved communication strengthens the
patient/physician relationship, improves patient compliance with
treatment recommendations and instructions, increases both patient
and physician satisfaction, and helps reduce malpractice claims.
Numerous studies report that over 60% of malpractice cases involve
a failure in communication between patient and physician. Good
communication also educates the patient, shapes realistic expectations,
and creates true informed consent.
a) develop and implement communications programs
and information for physicians that focus on key areas:
* Checking patient understanding
of information and instructions
* Welcoming and inviting questions from patients during all phases
of diagnosis and treatment
* Improve informed consent procedures by offering clear guidelines
for physicians.
* Dispute resolution.
* Conversations about errors (See Liebman, C. and Hyman, S. A
Mediation Skills Model to Manage Disclosure of Errors and Adverse
Events to Patients, Health
Affairs23(4):23-32, 2004. © 2004 Project HOPE).
b)Provide written materials to give to patients about
dispute resolution and alternatives to malpractice claims.
c) Provide written information for patient waiting
rooms on important issues impacting their healthcare (reimbursement,
malpractice, patient responsibility, actions they can take, and
more.)
4. Professional Relationships Challenge:
While some physicians create
positive, cooperative, and collaborative relationships with other
physicians and colleagues, others create a relationship climate
with colleagues, both physicians and other healthcare professionals,
that is negative and distressing, and in other situations manipulative,
adversarial or unethical.
Create a committee in your local
medical association and your state association to identify the
top three areas of failure or weakness of ethical partnership
with colleagues. Create recommendations and timelines to change
those behaviors and encourage all members to implement the recommendations.
Some areas to address might include
the following:
a) Create clear guidelines for physicians of patients
who have experienced injury, error, or negative outcome with
another physician, especially when considering recommending that
a patient contact an attorney.
One article stated that over
69% of people who filed malpractice claims were advised to do
so by a subsequent treating physician. In the same source it
is reported that 38% of the malpractice claims filed were filed
by healthcare professionals. ( Linda S. Crawford, "Why
winners win," Norcal Forum (Dec. 6, 20030 as quoted
Richard J. Andolsen, MD in Why
Do Patients Sue Doctors?)
Andolsen reports that subsequent
treating physicians can be affected by 'outcome and hindsight
bias' . In addition, they often receive only the presentation
of the situation from a patient who is angry, who is presenting
themselves in the best light and often the previous physician
in the worst. The subsequent physician often has no information
about the original physician's thinking and decision-making.
According to Andolsen, "sometimes their ego convinces them
they would have done much better than the original physician."
Dr. Andolsen emphasizes that although the original physician
made different decisions or treated differently than the subsequent
physician would, it does not mean that the original physician
did not provide an adequate standard of care.
Therefore Andolsen recommends
the following:
* ask the patient to discuss the case with the original physician
since that physician is the one that can explain the reasons
and decisions involved.
* acknowledge to yourself and the patient that you are receiving
partial information that makes completely accurate judgement
very difficult.
* talk to the original physician yourself to find out the facts
and see the decision from his or her perspective.
* if you are concerned about patient welfare, report the original
physician to the professional standards committee of your association
and/or the medical board of your state
b) Develop and implement clear guidelines for expert
testimony. (See Coalition and Center for Ethical
Medical Testimony , the
section on values and statement of direction)
c) Group practice relationships (some of the worst
behavior in professional relationships happens in group practices).
d) Relationships with nurses and others .
e) Physician / hospital relationships.
Part 2:
Find one way that you personally can create more ethical partnership
with colleagues in your group or closest association with other
healthcare professionals (physicians, nurses, others) . Identify
and change your behavior in one professional relationship every
six months aimed at creating more ethical and fair relationship
(even with people you have to work with that you don't like!)
Return
to Ethical Challenges Page
TAKE ACTION! JOIN US IN ISSUING THE
CALL TO ETHICAL HEALTH PARTNERSHIPS!
As always, I welcome your constructive
comments and suggestions about the material on this website and
how we can all be most effective in co-creating the kind of healthcare
system we all want. E-mail me at ideas@ethicalhealthpartnerships.org
© Dawn Lipthrott,
Ethical Health Partnerships, 2005 www.ethicalhealthpartnerships.org
(May be copied and distributed
as long as this identifying information is retained on copies.)
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