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Jun 13, 2022

There’s no denying that mistakes happen in medicine. When they do, what’s the next step? Business as usual is to deny and defend. Not only is this an adversarial and destructive process, it is also a lost opportunity to learn (and for the patient/family to fully understand what happened). In this episode, we explore a novel approach that shifts thinking from ‘risk management’ to ‘patient management’, which some argue is profoundly better for all parties involved in a medical error- clinicians, patients, and systems. 

Guest Bio: Peter Smulowitz MD is an expert in health policy and author of Disclosure, apology, and offer programs: stakeholders' views of barriers to and strategies for broad implementation.  He currently serves as Chief Medical Officer, Milford Regional Medical Center and is an Associate Professor of emergency medicine, University of Massachusetts Medical School.

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We Discuss:

  • The status quo for the way we handle mistakes creates multiple victims, but no winners.  [03:30]
  • It was the aftermath of an unfortunate case that sparked Smulowitz’ interest in this subject. It motivated him to try to make systems better so that others did not have to go through the same trauma. [06:30]
  • We are taught not to apologize after an adverse event. But is this good advice? [13:50]
  • Communication, Apology, and Resolution (CARe) programs have been developed to bring providers out of the shadows, encouraging them to talk about adverse events and encouraging a transparent process with the patients and families. [15:55]
  • How would you apply the CARe process to this hypothetical scenario:  a young woman with a viable pregnancy is mistakenly given methotrexate (which was ordered for the patient with an ectopic in the room next to her)?
  • What is the best way to deliver bad news and apologize effectively? [24:10]
  • The University of Michigan made the CARe program an institutional process. What happened after they started using it?  [22:05]
  • What are the barriers and strategies for implementation of CARe programs? [28:45]