The first thing to do after a medical error, with Anthony Orsini, D.O.

A patient is harmed, the error is real and the family does not know yet. Anthony Orsini, D.O., says fewer than half of physicians can name the steps they are supposed to take at that moment, and that what happens in the hour after an error often matters more to how it ends than the error itself.

Medical Economics Managing Editor Todd Shryock sat down with Orsini, a neonatologist, founder of The Orsini Way and a member of the Medical Economics editorial advisory board.

Orsini has been training physicians on difficult conversations since 2010, and he walks through the mistakes that most often turn a disclosable error into a claim: staying silent, getting defensive rather than transparent, retreating into medical jargon and letting body language contradict every empathetic word in the room. He explains why naming a cause before the review is finished is the worst move available to a physician, what changed at the University of Michigan after it moved from denying and deflecting to disclosing errors as they happened, why even a harmless error has to be disclosed, and who on the care team should deliver the news.

Orsini’s new Medical Economics series, Conversations that Matter, debuted Sept. 2. The first episode looks at why breaking bad news goes wrong so often.

Don’t miss our recent episodes on physician corporatization, malpractice rates, physician-owned hospitals and vaccine stocking costs.

Music Credits:

Ambient Jazz by AurbanniAudio - stock.adobe.com

A Textbook Example by Skip Peck - stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:26 | Cold open. Orsini on why the most empathetic words fail when a physician’s posture contradicts them.

0:26 – 2:00 | Introduction. Austin Littrell introduces the episode, the guest and the debut of Orsini’s new series.

2:00 – 2:35 | Meet Anthony Orsini. Todd Shryock introduces Orsini and The Orsini Way.

2:35 – 7:27 | The most common disclosure mistakes. Failing to disclose at all, getting defensive rather than transparent, retreating into medical jargon and ignoring nonverbal communication. Orsini cites a study finding fewer than half of physicians know the steps to take after an error.

7:27 – 9:59 | Why speculating is the worst move. The brain reads nonverbal cues before words, an angry family is a normal response, and naming a cause before the review is finished routinely turns out to be wrong.

9:59 – 13:33 | What families actually want to hear. Orsini says 39 states now have full or partial apology laws, and that in role-play training physicians more often over-claim fault than dodge it. A morphine dosing example shows why errors are almost always a process breakdown.

13:33 – 15:28 | The data behind transparency. Orsini walks through the University of Michigan findings on claims, liability costs and time to resolution.

15:28 – 18:02 | Training body language. Videotaped role play, the long sitter posture, and why a relaxed stance that builds rapport in a routine visit destroys credibility in a disclosure.

18:02 – 18:55 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

18:55 – 21:56 | Every error gets disclosed. Orsini tells the story of a minor morphine overdose a hospital chose not to report, and what happened when the mother found out anyway.

21:56 – 24:22 | Who should deliver the news. Why the physician should lead the disclosure rather than risk management or legal counsel, and how the pre-disclosure meeting should work.

24:22 – 27:11 | Be prepared before it happens. Why physicians avoid training for medical errors, what resources exist for practices outside a hospital system, and Orsini’s closing message.

27:11 – End | Closing thoughts and outro. Shryock thanks Orsini, and Littrell wraps the episode.