Ethical Health Partnerships

  Invitation To Physicians for Deeper Ethical Health Partnership

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Dawn Lipthrott, LCSW
Ethical Health Partnerships
1177 Louisiana Ave. #212
Winter Park, FL 32789



Ethical Invitations to Physicians

Individually and as a profession, you know better than anyone the areas in which physicians need to take responsibility for changes to improve health partnerships and patient wellbeing. I challenge you, individually, as a profession, and as specialties within medicine, to create more ethical health partnerships with both patients and with colleagues.

1. Help educate patients about issues affecting you and them:
Every physician's office should have brochures or flyers about current issues impacting our healthcare and your ability to provide it. We need you to help educate us so we can help you help us! We know far less than what you think and subsequently feel helpless. We are not. Imagine what could happen if only 10% of every physician's patients became educated and committed to action!

a) Call upon the AMA and other specialty associatings to coordinate the creation of professional materials that every physician can, and would want to, put out in their office to educate patients.
I recently read the AMA packet for physicians to use on malpractice. It was a turnoff to me because of blaming lawyers and blaming it solely on frivolous lawsuits. It's an insult to patients who know that while frivolous lawsuits may be part of the problem, it is not the whole problem. Also physicians are turned off by it and will not put it out. They don't want materials that 'point the finger' .

b) Encourage all physicians to use newly created materials in their waiting rooms.
Your offices are one of the best places for us to get our education about health policy. Tell us how it affects you, how it affects us, and how it affects our relationship as doctor and patient.

2. Invitation and Challenge to Improve Patient Safety:
Patient safety should be the first area addressed because it protects patients and protects physicians. While definite improvement is being made, there is a lot more that could be done. Anesthesiologists have led the way in making a specialty-wide commitment to improving patient safety and have created very positive results. Each specialty can best address its own procedures and potentials for error.

a) Preventing Errors:
Within six months of receiving this challenge and invitation, I would like each national specialty association, in collaboration with its members, to identify the top 3 most common serious errors that occur in that specialty. The errors may be due to physician, procedural, equipment, or systemic error.

Create a committee for each error in order to develop plans and procedures to eliminate that error. The committee would receive suggestions and information from the association membership to help develop the plan. Develop a timeline for information and implementing actions that will lead to the elimination of the error.

Post all errors identified, committee information (including contact information), plans and progress on the association website, available not only to the membership, but also to patients and other specialties. (I would be happy to put a link to your site from this one so that your work can inspire others!)

Part II:
After the first year of plan implementation, I challenge you (as specialty groups) to identify at the beginning of each calendar year the most common serious physician or systemic error in specific common procedures or treatments in your speciality and develop plans for reducing that error.

b) Professional Monitoring and Intervention of Physicians Who Provide Below Average Care:
The majority of physicians are caring, competent and committed to high standards of care and safety for their patients. But there are some that repeatedly perform at a substandard level. It is the duty of the medical profession and it's regulatory boards to protect patients.

Create a committee with physicians and members of the state medical regulatory board to identify 3 ways both physicians and the board can better protect patients from physicians who repeatedly practice at a substandard level that puts patients at risks. Create clear standards to identify those physicians and create appropriate phases of intervention . . . whether that be supervision, additional training, counseling, or discipline. While physicians need to be protected from unfair blame, firing or loss of privileges, patients need to be protected when a physician regularly demonstrates inadequacy or disregard for patient protection and quality care.

This should be accomplished within one year from the date of the formation of the committee and should have a method for physicians and others who are not part of the committee to provide input and suggestions.

Make these plans available to the public for information and feedback on regulatory websites.

Provide leadership to assist hospitals to do the same.

3. Invitation to Improve Communication:
Studies have shown that improved communication strengthens the patient/physician relationship, improves patient compliance with treatment recommendations and instructions, increases both patient and physician satisfaction, and helps reduce malpractice claims. Numerous studies report that over 60% of malpractice cases involve a failure in communication between patient and physician. Good communication also educates the patient, shapes realistic expectations, and creates true informed consent.

a) develop and implement communications programs and information for physicians that focus on key areas:

* Checking patient understanding of information and instructions
* Welcoming and inviting questions from patients during all phases of diagnosis and treatment
* Improve informed consent procedures by offering clear guidelines for physicians.
* Dispute resolution.
* Conversations about errors (See Liebman, C. and Hyman, S.
A Mediation Skills Model to Manage Disclosure of Errors and Adverse Events to Patients, Health Affairs23(4):23-32, 2004. © 2004 Project HOPE).

b)Provide written materials to give to patients about dispute resolution and alternatives to malpractice claims.

c) Provide written information for patient waiting rooms on important issues impacting their healthcare (reimbursement, malpractice, patient responsibility, actions they can take, and more.)

4. Professional Relationships Challenge:
While some physicians create positive, cooperative, and collaborative relationships with other physicians and colleagues, others create a relationship climate with colleagues, both physicians and other healthcare professionals, that is negative and distressing, and in other situations manipulative, adversarial or unethical.

Create a committee in your local medical association and your state association to identify the top three areas of failure or weakness of ethical partnership with colleagues. Create recommendations and timelines to change those behaviors and encourage all members to implement the recommendations.

Some areas to address might include the following:

a) Create clear guidelines for physicians of patients who have experienced injury, error, or negative outcome with another physician, especially when considering recommending that a patient contact an attorney.

One article stated that over 69% of people who filed malpractice claims were advised to do so by a subsequent treating physician. In the same source it is reported that 38% of the malpractice claims filed were filed by healthcare professionals. ( Linda S. Crawford, "Why winners win," Norcal Forum (Dec. 6, 20030 as quoted Richard J. Andolsen, MD in Why Do Patients Sue Doctors?)

Andolsen reports that subsequent treating physicians can be affected by 'outcome and hindsight bias' . In addition, they often receive only the presentation of the situation from a patient who is angry, who is presenting themselves in the best light and often the previous physician in the worst. The subsequent physician often has no information about the original physician's thinking and decision-making. According to Andolsen, "sometimes their ego convinces them they would have done much better than the original physician." Dr. Andolsen emphasizes that although the original physician made different decisions or treated differently than the subsequent physician would, it does not mean that the original physician did not provide an adequate standard of care.

Therefore Andolsen recommends the following:
* ask the patient to discuss the case with the original physician since that physician is the one that can explain the reasons and decisions involved.
* acknowledge to yourself and the patient that you are receiving partial information that makes completely accurate judgement very difficult.
* talk to the original physician yourself to find out the facts and see the decision from his or her perspective.
* if you are concerned about patient welfare, report the original physician to the professional standards committee of your association and/or the medical board of your state

b) Develop and implement clear guidelines for expert testimony. (See Coalition and Center for Ethical Medical Testimony , the section on values and statement of direction)

c) Group practice relationships (some of the worst behavior in professional relationships happens in group practices).

d)  Relationships with nurses and others .

e)  Physician / hospital relationships.

Part 2:
Find one way that you personally can create more ethical partnership with colleagues in your group or closest association with other healthcare professionals (physicians, nurses, others) . Identify and change your behavior in one professional relationship every six months aimed at creating more ethical and fair relationship (even with people you have to work with that you don't like!)


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As always, I welcome your constructive comments and suggestions about the material on this website and how we can all be most effective in co-creating the kind of healthcare system we all want. E-mail me at

© Dawn Lipthrott, Ethical Health Partnerships, 2005
May be copied and distributed as long as this identifying information is retained on copies.)