Repeating Back During Disclosure Meetings...

Repeating Back During Disclosure Meetings A couple weeks ago I published an e-newsletter concerning the family and patient perspective during disclosure.  I had gotten the idea to write this e-newsletter from a risk manager friend who is really stressing the family perspective in her disclosure program.  Well, after publishing the newsletter, the friend wrote in with a good critique concerning my advice of asking the family/patient to repeat back what was said during disclosure (in order to learn if they are really understanding what is being said).

First, the friendly risk manager said it's really important for clinicians/disclosurers to repeat back to the patient/family during the disclosure process.  Excellent advice.  Repeating back someone's complaint is how we validate (but not necessarily agree with) a complaint or perceived problem.  It shows we are really listening, and trying to understand...and for some people that all it takes to resolve the situation.  A lot of people just want somebody to listen.  Moreover, repeating back gives a chance for the patient or family to add any additional comments or concerns.  Get everything on the table.  Finally, the act of repeating back buys the disclosurer time to figure out what they are going to say next.  All good stuff.

Second, however, my friend was concerned that my advice about asking the patient/family to repeat back what they heard might be a little blunt.  It could be very hurtful to have a grieving family verbalize the details of a death.  Also, if the family or patient states the information incorrectly (because they didn't hear everything or, maybe, they have already formed an opinion that you killed mom), then there is the possibility of an argument ensuing.  Fair critique.

I have always advised that disclosurers ask the patient/family to repeat back what they have heard to make sure they are understanding the message(s) being communicated to them…but the way this advice was given is too blunt.   We don't want to further traumatize people or get into an argument.  However, we do want to know what people are thinking, especially if they are not on the same page with us!   If we are trying to communicate that mom died because of a known complication, but the family believes we killed her, we need to know that....and try to get everyone on the same page!  So, we need to ask some very gentle questions, such as: "As a doctor, I often use a lot of jargon…I just want to make sure everything I am saying makes sense.  Is it understandable?   What questions do you have?   What would you like me to review again so this all makes sense?"  Think of other gentle and subtle questions that do NOT involve yes or no answers.

Another thought is just to keep people talking...the more people talk, the more you have a chance to learn what they are thinking.

Another thing to keep in mind is we have begun recommending this year that you make a formal interview of the patient/family part of your review process.  Great way to learn what people are thinking.

Finally, there will be times when good people agree to disagree.  A thorough, credible review - which included the family being interviewed - says known complication.  However, the family thinks you killed mom and wants to pursue litigation, and they won’t budge from this position.  Unfortunate, but we're still OK, because will fall back on our documentation during the disclosure process and our relationship with the PI bar.

Have a great weekend.

Sincerely,

-Doug

Doug Wojcieszak, Founder, Sorry Works!