communication

Doctors Are Losing Money By Failing To Communicate

Medscape article by Wayne J. Guglielmo, MA

Breakdown in Communication: Costly and Dangerous

“What we’ve got here is failure to communicate,” the Captain, a prison warden, famously said to his stubborn prisoner in the 1967 film classic Cool Hand Luke. It’s far from a friendly pronouncement, of course. But too often, communication channels really do break down, and the results in the medical arena can be especially dire, even catastrophic. That’s the underlying message of a new report by CRICO Strategies, a Harvard-affiliated group of evidenced-based risk-management companies.[1]

“When information falls through the cracks, diagnoses are confounded, procedures are complicated, and subsequent care is compromised,” says Heather Riah, CRICO’s assistant vice president.

To probe the problem of communication failure, researchers looked at 23,658 medical malpractice cases filed between 2009 and 2013. (The CRICO database, which reflects the medical liability experience of more than 400 US hospitals and 165,000 physicians, contains 350,000 cases overall.)

Of the cases examined, communication failures of one kind or another contributed to patient harm in about 30%, or 7149, of the cases. Most failures occurred in surgery (27%), followed by general medicine (13%), nursing (9%), and obstetrics (5%). The inpatient setting—including the emergency department—accounted for 52% of the communication breakdowns, while ambulatory and other settings accounted for the remaining 48%. Researchers also found that 37% of all high-severity injury cases—including wrongful death cases—involved a communication failure.

Communication breakdowns were almost evenly split between clinician to clinician and clinician to patient, with some overlap between the two categories. On the clinician-to-clinician side, the most common breakdown involved a miscommunication regarding a patient’s condition (26%), followed by poor documentation (12%) and failure to read the medical record (7%). On the clinician-to-patient side, breakdowns included inadequate informed consent (13%), unsympathetic responses to patient complaints (11%), and inadequate medication instructions (5%).

The report found that cases triggered by clinician-to-clinician communication failures were more likely to result in a payout than those centered on clinician-to-patient communications (49% versus 35%). The average payouts in cases involving communication lapses between clinicians were also higher: $484,000 versus $381,000.

What can be done to address these breakdowns? Researchers propose a greater emphasis on empathy—thereby increasing the odds that information is not only conveyed but received and well understood—and a more effective consent process, which is especially critical prior to surgery.

Would a Higher Med-Mal Cap Keep the Concept Alive?

A bill that would have raised Indiana’s $1.25 million medical malpractice cap died a quiet death late last month, according to a story on the website of WFYI, the Indianapolis-based public radio, TV, and news station.[2]

Almost to the end, the bill’s chief sponsor, GOP State Senator Brent Steele, was hopeful that ongoing discussions between hospitals, doctors, and trial lawyers would result in a workable agreement. But when the parties to the talks got a glimpse of an actual proposal draft, they had second thoughts. “You and I can both be sitting at a table, and I’m saying something and you’re saying something, and we think we’re on the same page until you see it in black and white and…say, ‘Well, that’s really not what I thought it was,'” says Steele, who has vowed to introduce his bill again in the next session.

Why is a Republican lawmaker pushing so hard to raise his state’s med-mal cap? The apparent answer: because it hasn’t been raised in 17 years. But there’s also widespread belief that the proposed hike is part of a wider GOP strategy to make the 1999 law less susceptible to a constitutional challenge by those who think it’s unfair.[3]

Had it passed, Steele’s bill would have raised the award for an injury or wrongful death by $400,000, to $1.65 million, with future increases tied to the Consumer Price Index (ie, inflation). It would have also introduced two other significant changes: First, it would have increased—from $250,000 to $450,000—that part of the $1.65 million total award payable by the provider. (A state fund would be responsible for the remaining payout.) And second, it would have raised the amount a plaintiff could seek to recover without first going through the state’s mandated medical review panel.

After discussions broke down, Steele refused to point fingers, but historically the Indiana State Medical Association has argued that raising the state’s cap would inevitably drive up costs for its members.

Allegedly Dangerous Surgeon Flees the Country

Attorneys for an Ohio spinal surgeon being sued by hundreds of his former patients have asked to have the cases against him and the several hospitals where he practiced moved from county to federal court, as a story posted on the website of WCPO, a TV station located in Cincinnati, reports.[4]

Between 2007 and 2013, the surgeon, Abubakar Atiq Durrani, a native of Pakistan, performed surgeries at several Hamilton County, Ohio, hospitals: West Chester Hospital, Cincinnati Children’s Hospital Medical Center, Good Samaritan, Christ, and Deaconess. In late 2013, federal prosecutors charged Durrani with performing unnecessary surgeries that resulted in serious bodily injuries to dozens of patients. Following the indictment, Durrani fled the United States and returned to his native country, where he’s reportedly employed by a Pakistani hospital as chief of spinal surgery.

In October 2015, the US Department of Justice announced a $4.1 million settlement with one of the hospitals where Durrani operated, West Chester Hospital, and its parent company, UC Health. The settlement closed the books on federal charges that the hospital had submitted Medicare and Medicaid claims for medically unnecessary spinal surgeries performed by Durrani.

But hundreds of civil lawsuits against the surgeon and the hospitals where he practiced are still pending, a delay that the defense’s motion to switch from county to federal court will almost certainly lengthen.

“The only reason that they are doing this is to delay trial,” says the spokesman for the firm representing 523 of Durrani’s former patients. “This is the biggest medical malpractice case in the history of the Tri-State…a half-billion to a billion-dollar problem for these hospitals.” (The Tri-State area in this instance refers to Ohio, Indiana, and Kentucky.)

References

  1. CRICO Strategies. Malpractice Risks in Communication Failures. 2015 Annual Benchmarking Report.http://www.rmfstrategies.com/Products-and-Services/Comparative-Data/Annual-Benchmark-Reports/ Accessed February 1, 2016. [Requires registration.]
  2. Daudelin D. Effort to reform Indiana’s medical malpractice law stalls. WFYI.org. January 26, 2016.https://www.wfyi.org/news/articles/effort-to-reform-indianas-medical-malpractice-law-stalls-in-senate Accessed February 1, 2016.
  3. Colombo H. GOP plots revamp of medical malpractice law. IBJ.com. January 16, 2016. http://www.ibj.com/articles/56680-gop-plots-revamp-of-medical-malpractice-law Accessed February 1, 2016.
  4. Christian P. Medical malpractice cases against local hospitals, spinal surgeon, could be moved to federal court. WCPO.com. January 9, 2016. http://www.wcpo.com/news/insider/medical-malpractice-cases-against-local-hospitals-spinal-surgeon-could-be-moved-to-federal-court Accessed February 1, 2016.
Doctors Are Losing Money By Failing To Communicate - overview

Summary: "What we've got here is failure to communicate," the Captain, a prison warden, famously said to his stubborn prisoner in the 1967 film classic Cool Hand Luke. It's far from a friendly pronouncement, of course. But too often, communication channels really do break down, and the results in the medical arena can be especially dire, even catastrophic. That's the underlying message of a new report by CRICO Strategies, a Harvard-affiliated group of evidenced-based risk-management companies.

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