Dr. Jo Shapiro, who directs the hospital’s Center for Professionalism and Peer Support, guides clinicians on how to conduct one of the most fraught conversations a doctor will have with a patient: one in which a clinician discusses an unexpected outcome or discloses a medical error and offers an apology.

Shapiro said these conversations represent “a moment of vulnerability for patients and families, and for clinicians the vulnerability was around shame and guilt and fear.”

“Clinicians may face fear of reputation, fear of punishment, and, now, a fear of harm.”

In her coaching sessions, Shapiro says she stops clinicians frequently to point out the importance of pausing and soliciting questions, and avoiding phrases shaded with defensive connotations, for instance, or complicated medical terminology that might signal obfuscation.

Such lapses can make it more difficult for a patient to deal with the emotional impact of learning difficult news, and they can spark a patient’s anger, Shapiro said.

“These situations are all about bearing the weight of the patient’s or family’s pain, no matter how horrible that might be for the clinician,” Shapiro said. “A lot of empathy training misses that self-regulation element, and that’s a building block that’s absolutely teachable.”

By the same token, Shapiro said she teaches clinicians that they shouldn’t tolerate aggressive behavior. “If anybody is acting in a threatening way, you have to leave or get help.”

Victims of medical errors say they understand the impulse to rage, if not violence.

In 1999, Linda Kenney, who at the time worked in the hospitality industry, entered Brigham and Women’s for ankle surgery. The anesthesiologist administered a nerve block that reached Kenney’s blood stream instead of the nerve, and she went into cardiac arrest.

By chance, surgeons were preparing for cardiac surgery in a nearby operating room and had a cardiopulmonary bypass machine ready. The heart surgery team bumped the scheduled patient, opened Kenney’s chest, and saved her life.

Kenney’s husband was waiting upstairs when her orthopedist and the anesthesiologist opened the door. “My husband physically and verbally went after him,” Kenney said. “We joke that if it hadn’t been for the orthopedic surgeon, he’d have been in the ICU with me.”

The anesthesiologst tried to see her several times while she was in the hospital, but he was blocked by her medical team, who felt his presence might traumatize her. Her husband later made amends with the doctor. And a week after she was discharged, he sent Kenney a letter apologizing and encouraging her to contact him.

Six months passed before she arranged to meet him for coffee.

The conversation went well, Kenney said, because the anesthesiologst approached it with empathy and contrition. “When you have those conversations you can’t add insult to injury,” she said.

With the anesthesiologst’s support, Kenney went on to establish Medically Induced Trauma Support Services, a Boston-based organization to support patients and clinicians who have experienced “adverse medical events.”

Through her own experience and similar ones from other patients, Kenney said she learned that most victims of medical errors don’t resort to violence. “But you have to be aware that anger is part of the process,” she said.

For many clinicians in Boston, a painful irony hovers over Davidson’s killing. He was widely known for his compassion. Not only had he treated the mother of the man who attacked him with error-free care, on the day of the shooting he had interrupted his scheduled appointments to speak to the assailant at length before the shooting.

Wyatt, of the Joint Commission, said his own survival was a matter of luck as much as empathic communication.

Once he sat down with the aggrieved parents, he knew he would get out of the room alive.

“I also remember thinking they deserve to know what happened,” Wyatt said. “And I also thought about the pain these people had been in, and as painful as it was for them and me, we needed to have this conversation.”

After the couple left the room — a “near miss,” Wyatt said — he let the matter sit.

He never heard from them again.


Link – https://www.statnews.com/2015/11/20/patients-violence-hospitals/