State of sorry affairs
Apology is a powerful method by which positive relationships are re-established after an incident of perceived or actual harm [Malpractice Consult, January 9, 2009]. Appropriately apologizing reiterates that physicians are fallible humans first and that medicine is uncertain.
When we apologize, we recommit ourselves to searching for remedies and preventing future harm. Unrealistic expectations, from both sides, can then be reduced. The goal of apology is forgiveness even for minor harm or violation. Forgiveness, in the context of apology, means the willingness of the "harmed" party to continue the relationship, not seek revenge, to feel closure, and to look to the future. Apologies, like everything else, can be articulated poorly or well.
Failure to incorporate all or some facet of an apology will leave the physician with a burden of fear/guilt and the aggrieved patient with a load of unresolved anger. An opportunity to function as adults in a fallible and uncertain world and to problem-solve together will be lost.
Not apologizing because you are worried about an insurer denying coverage or increasing premiums-as if the act of apologizing admits culpability or direct causation-is capitulating to paranoid defensive medicine.
Steven Kern asks for a legal solution precluding the admission of an apology in a malpractice case. Medicine is an inexact human science. Solutions to mistakes and medically associated harm must come from a culture of safety science, not from the legal domain.
JOHN-HENRY PFIFFERLING, PHD, Director, Center for Professional Well-Being
DURHAM, NORTH CAROLINA
CCHIT . . . illegal?
It's imperative that President Obama go slow ["HIT experts warn about EHR investment in open letter to Obama," InfoTech Bulletin, January 30, 2009]. There are a lot of industries that need a bailout more than the medical industrial complex. Without the unneeded taxpayer money, the likes of GE, NextGen, Greenway, and Allscripts will eventually sink due to their cost and complexity.
I would begin by having government quit sponsoring CCHIT, which is responsible for favoring expensive "certified" EHRs that serve little purpose for physicians.
In my opinion, CCHIT is illegal. It skirts anti-racketeering laws, destroys competition, and has taken HIT into the wrong direction. I agree with forming an infrastructure for interoperability, which should be completely paid for by CMS/Medicare and which should allow the practitioner to select and purchase the EMR of his choice, basic or complex, certified or not, since the EMR should simply be a tool for gathering information.
Dr. Scherger is correct in calling the current HIT expensive and offering little to nothing in terms of quality, prevention of errors, and return on investment.
AL BORGES, MD
Bend a politician's ear
I admit that I didn't read the article "The rating game" [December 5, 2008] because I would have seen red. I see red enough times per week from the HMOs I have to cope with.
However, I greatly enjoyed all but the first letter responding to it [Talk Back, January 23, 2009]. Are we all writing to our politicians to tell them of our dissatisfaction? We cannot depend on the big groups who supposedly represent us. We should do it ourselves. The quotation of Dr. Porras-"One day, American politicians are going to wake up wondering where the doctors went"-should be used in these e-mails.
ANN EWALT HAMILTON, MD