Disclosure Pro Tip: Dealing with "Upstream Docs"

Over the years a standard scenario I have taught involves a knee replacement gone wrong. The patient is miserable, the knee is worse than before, and our unhappy patient seeks out help from a new orthopod. And the conversation with Doc 2 start may start in this manner: "The first surgeon screwed up; he really butchered this knee...it's worse than before! Can you look at the chart and give me your thoughts about suing Doc 1?"

Dangerous territory for most orthopods. Ignore or minimize the patient's feelings and you have become part of the problem. Conversely, agreeing that the patient is correct, malpractice occurred, sue the incompetent Doc 1, etc, and you have breached ethical protocol. Even the little sighs and eye rolls that docs exhibit when hearing about care that went potentially wrong with another colleague is bad. I always remind docs that you were not involved in the care up to that point...you don't know what the prior condition of the patient was, what informed consent looked and sounded like, the willingness of the patient to be compliant, etc. The ethical middle road is to 1) acknowledge the pain and anger in an empathetic, caring fashion; 2) direct the patient back to Doc 1 with questions you would want asked and answered if the patient was your family member; 3) transition the discussion to what you can do medically to get the patient the outcome they desire. Directing patients back to their original physician can be important part of the healing process, both physically and emotionally.

This past week I was conducting a training seminar for a large hospital and a cardiologist asked me a question in this realm. This physician said he typically operates on patients in which the care up to that point has not worked for a variety of reasons. He said patients are not only sick when they come to him but can also be angry at prior treating physicians and are entertaining thoughts of malpractice litigation, complaints to regulators, and/or nasty posts on social media, and they may want him to dump on the prior treating physicians. I shared with the cardiologist the advice stated above, he thanked me, and then asked up a follow up question: "What about Doc 1 in your scenario? Often, I have referring relationships with these 'upstream docs" and even personal, friendly relationships with many of them. Do I alert these physicians that I am sending an angry, upset patient full of questions back to them?"

My answer: Yes, if possible. If I was Doc 1, I would want to know if one of my patients -- customers -- was unhappy and what had upset them to the point of spilling their medical beans with a colleague of mine. I think this is common courtesy. Now, some patient safety advocates will take me to task by saying I am possibly suggesting we are tipping off Doc 1, giving him/her time to prepare, alter the records, and a thousand other nefarious things....all of which could happen. Remember, however, in trying to rebuild the ethical framework of the medical culture we have to take some leaps of faith and look towards the better angels of our fellow humans. This type of question has same sting as a common refrain from some defense attorneys who believe docs/nurses can't be trusted to the say the right thing post-event so they should just say nothing at all and break off communication with the family (and get ready for the lawsuit). Again, we need more faith and trust in our medical people. So, yes, tell the colleague upstream about your conversation and ethically work towards a solution for the patient. Learning what did or did not happen upstream is critical to the healing and long-term prognosis of any patient.

At Sorry Works! we love working with healthcare, insurance, and legal professionals. We have been offering this training longer than anyone else, and we have the lowest price in the industry -- period. Give us a call today at 618-559-8168 or e-mail doug@sorryworks.net.

Sincerely,

- Doug

Doug Wojcieszak, Founder and President,
Sorry Works!
618-559-8168 (direct dial)
doug@sorryworks.net