Medicine Leads a Movement Toward Greater Transparency to Improves Patient Safety, Mitigates Risk

David B. Troxel, MD, Medical Director, The Doctors Company

The medical profession is part of the cultural shift happening throughout our society toward greater transparency—and this is benefiting physicians, as well as patients. I like to think that our profession has been a leader in this area with the movement to disclose medical errors, which began about twelve years ago. Because of this movement, many hospital systems are using Communication and Resolution Programs (CRPs) to guide patients, families, physicians, and staff members when adverse events occur.

We know now that when a medical error occurs, disclosure and transparency often reduce the patient's anger, and anger often leads to a medical liability claim. And greater transparency may mitigate risk on a larger scale as well: When analyses of adverse events leading to claims are made available to physicians, this often reduces their future occurrence, i.e., it reduces the risk of specific missed diagnoses, thus improving patient safety and reducing physician liability risks.

CRPs teach hospitals, medical practices, and physicians how to respond to an adverse event. For example, medical professionals learn how best to respond when explaining why a wrong diagnosis was made or explaining why a pharmacy released the wrong medication. And CRPs stress the importance of offering to help, such as by reassuring the patient that healthcare costs resulting from the error may be ameliorated by fee reduction or waiver.

At The Doctors Company, we encourage our physician members to participate in structured disclosure programs, and we provide resources to educate and assist them.

By reviewing our closed claims data, we can achieve valuable insights, such as which diseases are most frequently misdiagnosed. By sharing our findings, we alert physicians to the most frequent causes of claims in their specialty, thus increasing patient safety and lowering physicians' liability risks.

I can offer an example of how studying our data, and distributing the results of our studies, have yielded positive outcomes for patients and physicians.

Difficult Diagnosis: Spinal Epidural Abscess. When we completed a study several years ago of closed claims in hospital medicine, the most common claim allegations were diagnosis related. Of these, we were surprised to see that there were a significant number of claims for missing a diagnosis of spinal epidural abscess.

Spinal epidural abscess is so uncommon that many physicians have never seen one. So we shared our study with the Society of Hospital Medicine, and they agreed to publish our study in their medical journal and present the findings at their national meetings. Meanwhile, I wrote an article on our findings in The Doctor's Advocate, our quarterly publication. We've seen a gradual decline in the incidence of claims related to spinal epidural abscess as a result of sharing this data with physicians.

Sharing closed claims data is one of the most important things we do at The Doctors Company. This information is available to anyone on our website, and we encourage all physicians to review these studies.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.