Easing the Harm From Medical Errors: Q&A with Sorry Works! Founder Doug Wojcieszak
I have spent a lot of time with patients who have been harmed by medical error and the patient advocate community, largely made up of these patients and their families and friends. In this crowd, there is a lot of discomfort over the Sorry Works! program. They tend to like the message that health care providers should apologize and compensate patients when they make an error, but they don't like that Sorry Works! is a for-profit business instead of a charity. And they don't like efforts by Sorry Works! To make it harder for patients to see the full malpractice histories of their medical providers.
I asked Sorry Works! founder Doug Wojcieszak about these critiques and about the birth of his program in a series of emails. The interview below has been edited for space and clarity.
Q: When we talk about the number of patients harmed every year by medical error, there are wide ranges of estimates. I've seen anywhere from 100,000 to 200,000 patients every year who are killed, which is a lot of people, and then, on top of that, there are the patients harmed but not killed. What estimates do you tend to use and why?
A: I always reference the Institute of Medicine report from 1999 saying 45,000 to 98,000 people per year, but, also say many studies say the number could be higher much higher. I also think the analogy that basically states, "If a jumbo jet crashed every day, the public would clamor for quick yet meaningful fixes to aviation safety problems – yet we lose the same number of people due to medical errors daily but they die one at a time and nothing gets done" is a powerful visual that well defines the problem. Bottom line, there are far too many deaths and injuries due to medical errors.
Q: You experienced the pain of losing a family member because of a medical error. Tell me about that experience and how it informed the work you do now.
Losing my oldest brother to medical errors was a horrible, life-changing experience. It was a double-hit for me: Grieving for Jim (who was like a second father to me), but also watching my parents (whom I adore) grieving for their oldest child. I would finish crying for one, then start crying for the other, and repeat the process over and over. It took a long time for the wound to scab over.
I still grieve over how Jim's unnecessary passing has changed and harmed our family. However, my family always taught me that good can come out of bad. You simply have to keep going and never give up. Jim's passing and the way the hospital handled the event with silence and a cover-up combined with my professional political work on the medical malpractice issue for both tort reformers and the personal-injury bar taught me that most people were not addressing med-mal reform in the proper manner. Folks were talking past each other. They were saying, "Let's cap damages!" "Let's punish insurance companies!" They were not addressing the core reasons why people file medical malpractice lawsuits and why doctors and hospitals are sued.
Ten years ago, disclosure was in its infancy and struggling to get traction, but it really spoke to me as a family member and also as a political professional. I used my advocacy skills to form Sorry Works! and spread the word about the benefit and value of disclosure. Doing this work and training thousands of clinicians on disclosure over the last seven-plus years has been very cathartic for me. In 2012, I am happy to report that the debate about whether to disclose or not is settled. We won! And now hospitals, insurers, and practices are figuring out how to implement disclosure.
Q: What exactly led to your brother's death?
A: Jim died of a misdiagnosed heart attack. It was misdiagnosed because the hospital got Jim's charts mixed up with my father's chart. This was significant because my father, Raymond, had a perfect stress test two months before my brother's death. We know they had the charts mixed up because the computer monitor over my brother's bed read "Ray Wojcieszak." When my dad alerted the attending physician of the mistake, the doctor wanted to argue about who was who. Dad actually had to produce a driver's license to confirm identities. They changed the computer monitor to read "Jim Wojcieszak," but they were still using dad's charts. They diagnosed my brother with a bacterial infection of the heart. Jim was admitted on Tuesday, and he died on Thursday. The last afternoon of his life, Jim was spitting up blood, oxygen alarms were going off, etc. They ran a probe up his leg and found four arteries were blocked. Jim crashed during the test and died in emergency open heart surgery.
Q: Did you or anyone in your family sue and, if so, what was the outcome?
Q: Yes, my parents filed a medical malpractice lawsuit, and after a year and half, the judge forced a settlement. It was classic no-fault settlement: Money but no admission of fault or explanation of how things went wrong and would be fixed. It left a very hollow feeling that wasn't filled in until I was contacted by Catholic Health Partners two years ago. The company had purchased the hospital where my brother died. They heard through a mutual friend about Jim's story. They apologized and showed me the safety advancements that have been implemented since then. Moreover, I am serving on one of their quality committees and assisting in their disclosure efforts. It's very meaningful for me and has provided further closure.
Q: You write about incentivizing physicians to apologize after a medical error. How do we know that the apology will make a difference to patients or their families? If my child is killed by a drunk driver, I'm not sure I want an apology. I want justice. Isn't that what patients would want, regardless of an apology?
A: In our campaign proposal, we're not really trying to "incentivize" apology so much as we are trying to remove barriers - regulatory barriers. If you break a law with your automobile but then admit fault and make amends, the judge doesn't throw the book at you. It's about fairness and common sense.
Unfortunately, that does not appear to be the case with medical boards and the National Practitioners Data Bank. Clinicians who do the right thing post-event can actually be targeted by regulators showing they are trying to "get tough" on bad docs. This creates a feeling among some clinicians that "no good deed goes unpunished." That's what we're trying to change.
When someone truly apologizes – meaning they admit fault and make amends – that is the ultimate form of justice. It's also the ultimate act of transparency that allows patients and families to complete the grieving process while providing healing and closure for all sides, including the offending party. Too often patients and families "win" in court, but still feel hollow when they are handed a check but no acknowledgment from the doctor or hospital. Most patients and families don't want revenge. They simply want answers, accountability, and a commitment to improve medicine post-event.
Sorry Works! provides all of this. Patients and families can actually understand and accept mistakes if healthcare providers are forthcoming. Nobody is perfect! However, if communication is lacking and accountability not present, patients and families become angry and seek "justice."
Q: Shouldn't physicians who make mistakes – even understandable mistakes – just say sorry without expecting anything in return?
Yes. It's just when talking about disclosure and apology, we naturally have to walk through all the ins and outs, including the benefits. For too long, clinicians have been given horrible, unethical advice. They've been told, "Say nothing post-event!" We have to undo all those years of bad advice and encourage disclosure.
Q: When you start a conversation with hospital administrators about your program, what are the first few steps in laying the groundwork for how you would like to change the culture there?
Identify your champions in the organization. And the champions will be everywhere: medical staff, nursing staff, c-suite, risk, legal, etc. Find these champions, form them into a committee/team, develop your disclosure program and have these champions run the program. Then train, train, train the front-line staff on not only how to do disclosure, but also that disclosure is what you expect to happen post-event.
Q: What are some typical responses from hospital executives and physicians when you talk about your program?
Disclosure is accepted and endorsed now. The big challenges for the c-suite are:
* training front-line staff and getting the message down to all doctors and nurses
* having consistent ethics on all cases, not just the "big" ones which are clear-cut (dosing error, wrong-side surgery, etc).
It's almost easy to say we endorse disclosure, yet another matter to get that nurse at 2:00 a.m. to be empathetic in the immediate aftermath of an event. It's going to take many years of work before disclosure is a "reflex" for healthcare organizations and healthcare professionals, but we will get there!
Q: Some critics of Sorry Works! think that, because you are making a profit in an area where most advocacy is driven by volunteers and charities, you may be too narrowly focused only on solutions that will keep profits up. Also, your clients are the doctors and hospitals and not the patients, meaning you may be pushing for solutions that are better for the doctors and hospitals than for the patients. What do you say to these critiques?
A: I launched Sorry Works! in 2005 as an advocacy organization with a $0 budget. I had enough work coming in through my PR firm and other business that I could afford to put Sorry Works! out there and see if the message resonated. My initial goal was simply to get doctors/hospitals/insurers to think differently about medical malpractice reform and realize there was a better solution than tort reform and caps.
In 2005, I was initially spending five to 10 hours per week advocating disclosure through my website, media work, and e-newsletters. Then it caught fire. Soon I was up to 20-plus hours per week of charity work. Also, I started getting inquiries from hospitals and insurers asking for training on disclosure and apology for their front-line staff and clinicians.
I had (and still have) a passion for the issue, but I also have a family, mortgage, and my other business concerns. I had to generate revenue to support the cause. My choices were to incorporate Sorry Works! as a non-profit or as a business. I had spent years working in government and around non-profits, and I didn't want to spend the time and hassle begging for money – knowing it would never be enough and forever having to justify expenditures – when the need for disclosure training was immediate. I said to myself, "Instead of spending time writing grant applications, let's spend the time developing great content and let the market decide if the message is good." As a result, Sorry Works! is an Illinois limited liability corporation.
Over the past five years I have developed all sorts of content: books, webinars, etc. with one focus: Teaching disclosure. The Sorry Works! website receives, on average, over 400 unique visitors per day, and the Sorry Works! e-newsletters have nearly 3,000 unique subscribers. Sorry Works! has been featured in publications around the world, including Time, The Wall Street Journal, and many others. Through this business model, I can say without bragging that Sorry Works! has won the debate on disclosure.
Now, some patient safety advocates may think Sorry Works! is a corporate behemoth. We are not. I'm a micro-entrepreneur. I don't have a staff. I work solo and sometimes through partnerships. Moreover, I say exactly what is on my mind. I know this blunt approach has sometimes lost business for me.
But that's not the type of business I want anyway, because disclosure only works if it's credible. It has to be credible to patients and families, to the most aggressive trial lawyers, and to the most skeptical, jaded physicians. That means being empathetic and supportive when something goes wrong, but only saying what you know when you know it. If medical errors caused the harm, then fairly and quickly compensate the patients or their families. If the harm was not the result of an error, continue to be empathetic and supportive while fully explaining yourself.