Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 150 | July 20, 2021
Medical Liability And Risk Management
VP, Risk Management at PLICO
Welcome to Difficult Conversations with Dr. Anthony Orsini. On today’s episode, we’re going to talk about two topics that most people avoid: medical errors and malpractice lawsuits. My guest today is Shari Moore, Vice President of Risk Management at Physician’s Liability Insurance Company, also known as PLICO, in Oklahoma. Shari has more than twenty-three years of experience in the adult care setting, including nine years at Risk of Management and three years as Case Management. Her mission is to provide proactive risk management education to physicians across Oklahoma to improve the quality of experience for both the physician and the patient. As always, Dr. Orsini keeps his promise about two things, that you will feel inspired, and you will have learned valuable lessons to be a better and more compassionate communicator.
Shari tells us her journey from a Registered Nurse, to the Risk Management field, to her job at PLICO. We find out what attracted her to Risk Management. Dr. Orsini mentions the staggering statistics of how much medical malpractice lawsuits cost, and Shari talks about how important communication is in educating and training doctors to form relationships and avoid malpractice. She tells about PLICO, and how valuable it is for physicians to learn in-person and interact with other people who are dealing with the same issues. Dr. Orsini shares some important tips when he teaches conflict resolution. Shari shares advice on what she does to educate doctors and risk managers on how to reveal that medical error. Also, she tells us two big mistakes physicians make when it comes to having that conversation. We learn how the relationship should work with the risk manager and the doctor when medical errors occur. Shari tells us a few stories about people that attended their educational programs and how being compassionate, caring, and saying you’re sorry may help in preventing a lawsuit. Last July, PLICO just implemented a Proactive Litigation Support Program, and Shari fills us in on what that entails. Dr. Orsini talks about physicians having the highest suicide rate of any profession. They discuss the stresses involved when a doctor gets sued and how we really need to take care of our doctors and nurses if we’re going to help this issue. We end with Shari telling us the most difficult conversation that she’s encountered and advice on how to navigate through it, and Dr. Orsini shares a great little piece of advice his father told him at a young age. If you enjoyed this podcast, please hit follow, and download all the previous episodes to find out more about what we do and how we teach communication.
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Shari Moore (1s):
And what we found in those cases was poor communication led to the patient in many situations, going and looking for their answers from an attorney because they couldn’t get their answers from either the hospital, the physician or somebody that they trusted. And so if they were going to get any answer, they just went and asked an attorney to get an answer for them. And again, many of these lawsuits had obviously no basis. It was just more communication.
Welcome to Difficult Conversations: Lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week, you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you.
Dr. Anthony Orsini (1m 17s):
Into another episode of difficult conversations lessons I learned as an ICU position. This is Dr. Anthony Orsini, and I’ll be your host again this week. Today, we’re going to have a conversation about two topics most people don’t really want to talk about, and that’s medical errors and medical malpractice lawsuits. And few people are more qualified to speak about this topic. Then my guest today, Shari Moore, Shari Moore, graduated from the University of Oklahoma with a bachelor’s degree in nursing. She has more than 23 years experience in the acute care setting, including nine years at risk management, three years as case manager, five years as coordinator of nursing recruitment and retention, and six years as maternal child clinical nurse.
Dr. Anthony Orsini (1m 58s):
She is currently the vice president of risk management for the position’s liability insurance company. Also known as PLICO in Oklahoma city, where she has served for over 10 years. Her mission is to provide proactive risk management education to physicians across Oklahoma, to improve the quality of experience for both the physician and the patient. I love that mission and that’s, what’s going to be really the topic of today. I can’t wait to talk to Shari about this. Shari welcome, and thanks for taking time out of your busy schedule for being on.
Shari Moore (2m 30s):
Thank you for inviting me. I appreciate it.
Dr. Anthony Orsini (2m 32s):
You and I spoke a couple of months ago and I’m going to do a little work together, but I was so impressed. It seemed like you and I were always on the same page about everything when it comes to liability and the role that communication plays. And I’m so excited to kind of tease that out today, you know, medical liability and malpractice and medical errors is related to so many things in healthcare, including cost and physician burnout. And when we spoke last about communication and medical errors, but first before we get into really the deep dive of this, I just kind of want people to hear a little bit about your story. And I know you’re a registered nurse as you started out with, and now you’re in the risk management. I also see from your bio that think you’re a lifelong Sooner?
Shari Moore (3m 16s):
No, that’s that is, I have that on my wall. However, we are big Oklahoma state fans though.
Dr. Anthony Orsini (3m 23s):
Okay. All right. So, but Oklahoma, by all your life, you’ve lived in Oklahoma.
Shari Moore (3m 27s):
Yeah, I have. The university of Oklahoma is the only program at the time that had a bachelor’s degree in nursing. So I did all my pre-recs met my husband, and did all that at Oklahoma state. And we actually spend a lot of our time supporting the Oklahoma State Cowboys. All of my children are graduates. He makes me leave my university of Oklahoma diploma at the office.
Dr. Anthony Orsini (3m 52s):
Okay. Well, I love the Oklahoma state Cowboys uniforms. They’re very bright. I’ve always kinda been impressed with them and they do better than my Alma mater. Rutgers has been struggling for 30 years. I’ve been saying my whole life, I can’t die until Rutgers win something. And so when they were doing really well in the basketball NCAAs this year, I said to my wife, oh my God, if they ended up winning, does that mean I’m going to die? I don’t know.
Shari Moore (4m 16s):
Yeah. That’s awesome. Yes, we are. America’s brightest orange. So,
Dr. Anthony Orsini (4m 20s):
So tell us a little bit of how you went from registered nurse to risk management field and now your job at PLICO.
Shari Moore (4m 27s):
Well, it was really crazy. I obviously started out in maternal child health and was in the olden days we were, you know, split and there were, you know, the newborn nurses, the labor delivery nurses, the postpartum nurses. And I was in the era where they started doing cross training for everybody. And we were at had a level three NICU, and that was my primary area to work. And then they moved us in and all of us started doing post-partum and regular nursery. And then I was one of the first ones to go into labor and delivery to do that cross training and found really that I enjoyed that and what I really loved about it and what I found very unique about it was that I had a very different perspective.
Shari Moore (5m 7s):
And I’m sure you can appreciate this in your area. That I was really caring for two patients. Sometimes the labor and delivery nurses didn’t have a really good perspective, like, well, we’ll get the baby out and then we’ll take care of mom. And it’s like, I was looking at, oh, I’m kind of concerned about what the baby looks like when they come out and how they are. So that was kind of a unique thing. And then in the middle of that, I actually saw a position available for nurse recruitment and then moved into a large metropolitan hospital to do nurse recruitment. I took care of all their student programs and all those kinds of things. And it was a very busy, it was during the nursing crisis. I was with sometimes do 10 interviews a day trying to fill positions and things like that.
Shari Moore (5m 51s):
So I did that for about five years and the hospital where I was working at was it acquired by another corporation. And they split my job into three jobs, which was probably appropriate. And that’s when I went into case management and I actually was in your little neck of the woods doing NICU case management. I ran a lactation support service and did OB and NICU case management and did that for a couple of years. And then there was a job at the old hospital where I had originally worked in my community as a case management supervisor, and I was ready to get back to my own community. And so I moved into that job and immediately realized it was not what I wanted to do.
Shari Moore (6m 37s):
And so as a recruiter, I couldn’t have something on my resume that was less than a year. So I backed it up and started working on it. And about six months in the risk management position came open at the hospital. And I had actually just worked on a case with a child where there was an IV infiltration and I had to just basically risk managed it. I mitigated the risks. I set up home health. I did all of those things and knowing that’s what I was doing. And so I moved into the risk management job and the rest they say, I guess its history. It had been opened for about three months and they moved the office. I walked into an office full of files and incident reports and all the things that you get as a risk manager.
Shari Moore (7m 21s):
And so I hit the ground running. And so I was there for about 10 years. Also eventually was regional risk manager. As part of the corporation had 15 hospitals in five states across the United States. And then then PLICO came up and moved from being a, basically an overall kind of risk manager that I knew from being across the spectrum to much more proactive position at PLICO because at the hospital, I did all the claims manager responsibilities and all that, but at PLICO is all proactive. Pretty much once a claim is in, then it goes to another person to handle that. So early on was looking at disclosure, one of the first questions that the CEO asked me if I’d read, “Sorry, Works”
Shari Moore (8m 6s):
by Doug Wojcieszak which has, I had not read the book, but I was following his blog at the time. And so I knew what he was doing and I’d been actually managing planes like that in the hospital already. And so I definitely read the book, the second interview and came into PLICO, loving the fact that they were willing to look into disclosure, empathy and apology as a tactic for taking care, not only of our patients who were injured, but of our physicians. We were one of the first, this was in 2008 and nobody else was really doing it, our defense attorneys. Right, right. Our defense attorneys didn’t know what we were talking about. So we did a ground level defense attorneys, claims manager, everybody, and then into the physicians education about Sorry Work.
Shari Moore (8m 55s):
And so that just built into the whole communication issue.
Dr. Anthony Orsini (8m 59s):
What attracted you to risk management in the first place? And now that you’re still in it for all these years, what is it that attracted you to it?
Shari Moore (9m 5s):
Well, I think it is the problem solving. I love to look at something and try to work through it for the best outcome possible. I always say I’m a plain B kind of gal. There’s a lot of plan A’s that we would love to do in risk management that I know that the physicians, the hospitals, they can’t always do that. And so what can we do? What’s the best case, but what can we actually do that makes things better for the patient and for the physician. And I have always taken the tactic of, if you take care of your patients and they think you care about them, even if there’s a bad outcome, most likely they’re going to give you grace with that.
Shari Moore (9m 47s):
And so by making patients the priority and making their care a priority for the physicians and that attention to them, then you’re just going to have sort of the unintended consequences of not having a lawsuit, even if there’s a bad outcome.
Dr. Anthony Orsini (10m 5s):
I love that you said that. And in my book, I talk about my physician, who was my family doctor, Dr. Merck, and how he practiced for 50 years, I practiced so long. He delivered me. And then I did my rotation with them in medical school. That’s how long you practiced. Then people would say to him, when are you going to retire? And Dr. Merck would say, well, right before I die. And, and sadly, six months after he retired, he died. That was his life. Dr. Merck kept the records. I’m not advocating this, but Dr. Merck kept records on a five by nine index card. And, but he was an expert in building relationships and people loved him. And we talked about the concept in my book.
Dr. Anthony Orsini (10m 45s):
I talk about the concept of it’s hard to fire your best friends, which is, I love that saying. And so the statistics are staggering for people out there about how much medical malpractice lawsuits cost. The AMA estimated between 84 and $151 billion per year is spent either preventing malpractice, paying off malpractice or doctors, practicing defensive medicine because of that. And I think what I want to talk about now is the best defensive mechanism is not to order 25 laboratory tests that are probably not needed. The best defense system is to form that relationship with the patient in the first place. And to get them to like you, it seems like PLICO, and you are kind of ahead of the curve on this.
Dr. Anthony Orsini (11m 30s):
So I want to get into revealing medical errors later, but my father told me when I moved into my very first home, he bought me a toolbox with all the tools in it. And he said, you need them now because when you need them, it’ll be too late. And that is what I want to talk about today. We’re not really educating enough doctors on how to form those relationships and prevent the malpractice in the first place. And then we’ll get into how we’re not educating about medical errors. So how important is this communication training in this whole big number of $150 billion malpractice?
Shari Moore (12m 6s):
Well, interestingly, one of the things that I did when I came to PLICO about two or three years into it, we had been doing a lot of the communication stuff and we’ve done it in so many different ways. I think that is one thing that I’ve figured out is that, you know, the doctors learn differently. Primary care learn very differently than specialists. And so we’ve taken it from a lot of different perspectives and tried to throw it at them and try to see if some of it sticks. But one of the things that we’ve looked at, I had a board member who was retiring and he was going to come on as a consultant. And so I asked him what the first thing we did is we pulled like the top 10 at the time, we were not part of the larger MedPro group organization.
Shari Moore (12m 48s):
And so we couldn’t really trend any of our claims. We didn’t have a net. I mean, as a single state, there was just no way. And so I had him pull like the last 20, you know, high payout indemnity claims and to review them, to see if there were any things that we could look at. And quite honestly, these were just cases that it was just Murphy’s law. I mean, it’s just like, stuffs going to happen. You could put all the risk management tools in place in the world and probably these cases were still going to happen. And so it was kind of frustrating because, you know, so we took a completely different idea and started pulling cases where no indemnity was paid and looked at those.
Shari Moore (13m 34s):
And those that had a high amount of alae, the legal expenses. And that was what was costing us money because we weren’t paying out any kind of indemnity. And what we found in those cases was poor communication led to the patient in many situations, going and looking for their answers from an attorney. And so, because they couldn’t get their answers from either the hospital, the physician or somebody that they trusted. And so if they were going to get an answer, they just went and asked an attorney to get an answer for them. And again, many of these lawsuits had obviously no basis. It was just poor communication.
Shari Moore (14m 15s):
And it just reinforced to me the fact that a lot of the expense that we hear all about the big giant settlements, the big giant verdicts and all that kind of thing, that if you really kind of look at the bottom line of any NPL company, 80 to 85% of these are closed without payment to the patient. And so you’ve just got this blood of claims and lawsuits that probably don’t have any merit. They give a lot of discomfort to the physicians, to the patients who are involved and it takes away from their practice. And many times, if it only had one more time that she came to the office and you sat down and you said, this is what happened.
Shari Moore (14m 58s):
This is how it happened. Or we talked about it beforehand. This was a known risk. Do you remember our informed consent conversation? So we have a lot of those. We include that as well. You know, the whole conversation of adverse events starts at your informed consent process because you want to be able to reference back what you talked about. And so things like that. So that’s what we really have always concentrated on. And every year we do at least a portion of our education is related to communication skills in some form or fashion. And unfortunately the doctors who come to those are probably the ones who don’t really need it.
Shari Moore (15m 41s):
And again, you’ll, hopefully I, we hang it, we give them a carrot because they do get risk management premium credit on their renewals. And we hope that some people will just land in those classes that maybe it was just the best time for them. They don’t really care. They’re just showing up to get their credit. And again, we kind of just throw stuff out.
Dr. Anthony Orsini (15m 59s):
In fact, the American bar association made a statement. I think it’s over 10 years ago that patients are unlikely to file for malpractice if they feel a relationship with their doctor, even if prompted to do so. And so that’s why Dr. Merck went 50 years without getting sued. I’m sure he made mistakes. You know, he’s a good doctor. He wasn’t the greatest doctor that ever lived, but his patients wouldn’t even consider filing a lawsuit. And the communication for prevention is so important physicians, as you know, very small percentage of physicians account for a very large percent of malpractice lawsuits. And many of that is just their bedside manner. And the, I have a friend I just had as a guest, Jeffrey Seigel, who’s a neurosurgeon.
Dr. Anthony Orsini (16m 43s):
And now those is an attorney for malpractice and we discussed this, but I have a friend who just very recently had surgery, had some complications post-op pain. It was a complicated surgery and nobody did anything wrong. It was a neurosurgery. And she kept going back to the doctor until telling the doctor that she was having visual problems, et cetera. And he kind of lost his temper with her and told her to never come back. You’re cured. Don’t ever come back again. My job has done. And what did she do out of anger? She called an attorney and he could have prevented that in the book by Malcolm Gladwell, blink that as famous.
Dr. Anthony Orsini (17m 24s):
He talks about the famous study by Nalini Ambady. I don’t know if you’re familiar with that study, but she analyzed 36 surgeons a way back in 2002. I think she published. Half of them were sued multiple times. The other happened, never been sued. And she recorded interactions with patients with all those surgeons and then put it through a computer analyzed tome. And the computer was able to pick out which doctors had been sued just by analyzing tone. I mean, that’s staggering. So it sounds like PLICO is really on the forefront of this. And the fact that you offer credits, I think is really an incentive for people to go.
Shari Moore (18m 1s):
Well, another thing that we do and it’s of course in the pandemic, we couldn’t do it. But one of the things that we do is that I think is also so valuable for our physicians and other healthcare providers that we ensure is to get the maximum risk credit. We want you to be in-person with us. And that is something that I have seen over the last several years. And of course, last year, we’ll just leave it out. But the people who get together, they talk, they interact with each other. I think it’s super important from a burnout perspective, since we’ve kind of lost the physician lounge, our radiologists are second home, you know, looking at a computer.
Shari Moore (18m 43s):
I think you just had someone was talking about that. And just the opportunity to be together with like individuals who are dealing with the same thing. A lot of people say, oh, we don’t want to have to come. And it’s like, I promise you, I’m going to give you a great meal. I’m going to have you see your colleagues and talk to them and I’m going to give you great content. I’m going to give you great education. And on top of that, I’m going to pay you to come, basically. So that is another piece of it. When you talk about the burnout and especially over the last year, I think things have just gotten so difficult. And when I talk to people and then them reintegrating with their patients and also the patients and their own, I had a call from a doctor and it was like you said, it was a surgery that the husband ended up having a little bit of a more follow-up than was needed.
Shari Moore (19m 32s):
And the wife like lost it. And I said, well, let’s talk about what’s going on with the wife she’s got three kids at home she’s trying to educate right now. Now she thought this was going to be an overnight procedure. And now you had to keep him for a couple of extra days. He goes, oh, I know, no, I know. I feel totally. I mean, he totally got it. He just wanted to kind of talk to me, talk through what he could talk with her about. And he was totally able to deescalate that by recognizing where those people were coming for him that maybe had nothing to do with the surgery, had nothing to do with serving. And those are things that we see.
Dr. Anthony Orsini (20m 9s):
That’s an important tip that when I teach conflict resolution support and tip that when somebody is angry, don’t listen to what they say. I just had a conversation with a colleague recently who had a problem with a patient. I said, what does the patient really want? What are they asking for? Not what they said, as they’re speaking, I want you to listen to them and say, what do they want? Maybe they want control. Or maybe they want some answers. Maybe they want your time. Maybe they want compassion, or maybe as you alluded to before, they just want you to say, you’re sorry. Right? Yeah. So you really have to think about that. So, you know, many of my colleagues will say, oh, building relationships know that primary care doctors get sued less because they have longtime standing relationships.
Dr. Anthony Orsini (20m 52s):
But we also know that there’s some sub-specialists who rarely get sued also in that’s again, how they can form relationships, but you can form a relationship very quickly by learning how to communicate. And I think the work would of Nalini Ambady is really very important because we can teach doctors early on. Like my father had given me that tool box saying, you’re going to prevent it. But sometimes, you know, medical errors are a fact of life. We are human beings and things happen. In fact, one statistic says that medical errors. Now it’s the third leading cause of death in the United States. Things will go wrong. We’ve now trained doctors on how to build relationships and now something goes wrong. Let’s talk about revealing medical errors and how important that is to stop it.
Dr. Anthony Orsini (21m 36s):
So you have the first chance to stop. This is prevention. Now something happens and now you can prevent the lawsuit. So give us some advice and what you’re doing to educate doctors and risk managers on how to now reveal that medical error.
Shari Moore (21m 49s):
Well, I think what you said is about the toolbox is so important because we need to be able to know that the doctor knows in real time how to make that first conversation when something’s gone wrong. And that can’t always include having a call with us ahead of time. They’re going out after a surgical procedure or they’re they just gotten a call about a medication error or whatever, and they need to have a real-time conversation with that patient or that patient’s family. And so we talk a lot about that first conversation being very empathetic. That empathy is always okay to say, I am so sorry this happened.
Shari Moore (22m 34s):
We are going to be looking into what happened. This is exactly what we know now and we’re going to find out more information and we’re going to have a conversation later. But right now the important thing is we’re going to be taking care of your patient, your you or your family member. This is what we need. Even little things like saying, is there someone we can call for you? Do we need to get you a hotel room? You’re from out of town, you were not going to spend the night. We’d had something unexpected happen. And to have that initial conversation. And part of that is don’t say, oh my gosh, I think we screwed up. That’s part of the conversation because we always say you can’t put the toothpaste back to the tube.
Shari Moore (23m 15s):
And so don’t say something you don’t know, don’t assume don’t speculate on what it is that might have happened because you, even though it may seem really clear, once you go back in and look and see everything, it may not be the way it now looks right now.
Dr. Anthony Orsini (23m 38s):
And a perfect example of that. If you don’t mind me, interrupting is leaving a sponge in for surgery. And again, I don’t want people to think that you’re not supposed to say, you’re sorry, as you said, sorry is very, very important. But leaving that sponging is not a breakdown just of the surgeon. I mean, there are counts. There’s a process. There’s people that are in charge of counting the sponges, going in and counting the sponges going out. And so to a lay person, they would think that it’s really the surgeon sole purpose is to, but when actually that’s not true,
Shari Moore (24m 8s):
Right. I’ve seen several of those over the years that, I mean, they did everything, right. I guess, accepted the count. But I mean, even if the account was off, they did an x-ray. They did all those things and still didn’t, didn’t find it because of where it was or whatever. And then had to have figured that out, down the road, and then I’ve had people call it where that wasn’t even part of the process, because it wasn’t something that was typically that you did count. I had that in a labor and delivery case one time. And so, you know, just little things like that, but mainly just knowing it’s okay to go out express that this was not what you expected either.
Shari Moore (24m 49s):
And to say, I’m so sorry. And the main thing right now is we’re going to take care of you. And then also to remind them, if you say, you’re going to get back with them in three days, you better get back with them in three days, don’t promise something and not do it. Cause that’s worse. I’d rather you just giving them your cell phone number, giving them all of those resources so that you can answer questions. We always say it’s about staying on the same side of the table. And when someone calls me and they’d had something, a conflict with a patient, I will tell them our first advice outside of them being abusive to you, abusive to your staff or something like that. Our first advice is going to be, to maintain the relationship with the patient.
Shari Moore (25m 30s):
Because by maintaining that relationship, it decreases your risk of being sued. And then if you are sued and you’re still seeing them as a patient, what better defenses is there than that for, for them to say, well, Ms. Smith, I, I see that you still are a patient of Dr. Jones and well, yeah, it was great, you know, and all that. So yeah, I don’t know that I’ve ever actually seen that happen, but that’s because maybe they didn’t get sued.
Dr. Anthony Orsini (25m 54s):
What do you think the biggest mistake that physicians make when they have that conversation?
Shari Moore (25m 59s):
There’s two, two options. One is speculating of what happened and taking responsibility for something that maybe was either a process issue or was a known risk or the way that they talk about it. The patient doesn’t understand that it’s, it’s a known complication and that kind of thing. They think there’s something wrong. That’s the first thing is saying too much, too soon. Okay. And then the other one is saying too little, never. So those are the two opposite ends of the spectrum. I think of just saying, well, you know, or sending heaven forbid sending the nurse out to give the information, you know, or something like that. Cause they don’t want to deal with it.
Shari Moore (26m 40s):
And then avoiding the patient’s family during rounds over the next couple of days.
Dr. Anthony Orsini (26m 48s):
How about the role of the physician? As far as the person who’s breaking the news about the medical error and you know what I’ve seen in the past, there’s too many people in the room. So the doctor walks into the hospital bed to tell them about the sponge that was left in. And there’s an attorney, there’s a risk manager, there’s the charge nurse to PCC. And I think that right away, that causes a problem. How should the relationship work with the risk manager and the doctor and the revealing medical errors?
Shari Moore (27m 16s):
We handled it. And again, it’s, I’ve been at PLICO for over 13 years. So I’m in the hospital setting though. I would never even really tell anybody if I was going in with a patient with the physician, I would never tell them I was the risk manager. I would just say I’m representing the hospital as administration. And it would usually just be the two of us. And then what I also do and recommend, or outside the hospital setting, having the person in the practice that has the best relationship with the patient, because that may not be the physician, just depending on what has happened. It may be the nurse that they’ve talked to on the phone five times about getting back in or whatever, but making sure that it’s not like this random person, that they really don’t have a lot of contact with.
Shari Moore (28m 8s):
Let’s say that they really always see the PA and then they go and the surgeon is a surgeon and something happens. And then the surgeon is the one trying to maintain this relationship. You know, that may not be the best thing. The other people that are always a challenge. It’s a challenge for them are those physicians who don’t have patient contact like radiologists, like pathologists, you know, there’s a fair number of medical errors that happen kind of retrospectively you see things with those. And so not only are you teaching them about disclosure, you’re teaching them really about communication because they don’t have that interaction.
Shari Moore (28m 48s):
And so if it is something like a pathology error or radiology error, or is that really the best person to go and have that initial conversation that I do find, I think that not only for the physician, because it’s important to them, but for the patient, they need to at least hear from the person who was involved. It may not be the person leading
Dr. Anthony Orsini (29m 11s):
The overwhelming theme here in this conversation. And this is why I think you and I get along so well is the word relationship keeps coming up over and over again, as I do more and more teaching it. And I learned more and more about this subject. We train doctors, the ACGME, the American college of graduate medical education now says that doctors in training need to have some kind of training in revealing medical errors. And that’s interpreted in different ways. Some people interpreted that as a half an hour lecture, right? But we have some program directors who have contacted us at The Orsini Way. And we put residents through scenarios with professional actors and these actors are improv.
Dr. Anthony Orsini (29m 54s):
So they’re not told what to say or what to do. I mean, they’re amazing. They’ve been on TV, they’re great actors. And they’re asked to react to whatever they feel. And it’s amazing to me that we’ll see doctors who do it correctly. And we have one scene where a mammogram was missed for six months. And you have to reveal to the patient that her breast cancer now metastasized to bone because we missed it six months ago, terrible scenario. Everybody has a right to be angry with that, but we’ll have actors who will go through this scene with these. Some of these doctors, the doctor will do it beautifully. And in the end, the doctor’s hugging the patient, right? And then the next doctor will come in and their stuff being thrown by the actor.
Dr. Anthony Orsini (30m 39s):
And I’ll say to these actors who are very familiar with doing this, I just knew that first doctor was really upset about this and that she really felt empathy, as you said, right? And so you have so many ways that we can avoid this adversarial response, you know, first have the relationship in the beginning and then the second, but PLICO is doing some of it. But most doctors aren’t being trained in this, it seems to be the most cost-effective thing you could possibly do.
Shari Moore (31m 7s):
Right. Right. I know it’s funny because to me it’s just such common sense. So I don’t understand those two. Don’t give it enough credence. And in fact, I don’t know if you remember a couple of years ago, there was a study that came out that said, apology laws don’t have an effect on malpractice. And actually my ran MedPro group and I were at a conference for professional liability carriers and they were having a conversation about it. They were having a seminar, you know, a presentation about it. And if you deep dive into that, it’s actually, it’s only about the law. It has nothing to do with application of the strategy of empathy or disclosure.
Shari Moore (31m 53s):
It’s only this state has a law and this is their malpractice. This state has a law and it, you know, and that kind of thing. And so to me, it was a little bit misleading to say the least. And you know, you still have those sort of deniers that, that just don’t believe in it. And overall again, the people who attend our stuff, our educational programs, I have literally had people who, when we first started doing the disclosure things, they would come and they would say, thank you. That’s how I practice. And I’m just glad that PLICO is supporting me now. Or they would say I had something happened 10 years ago.
Shari Moore (32m 35s):
I delivered a baby. They’re the same age as my child. I see them once a week in school activities, there was difficulty with the delivery. And I’m still haunted by not just being able to say to them, I’m so sorry this happened. I’m feeling like I could do that. And so it allows physicians to continue to be physicians, their caregivers. And then we were asking them again, in the denying the fan thing, we’re asking the caregivers, which can’t be good for them. Can’t be good for them, especially not the really caring and compassionate ones.
Shari Moore (33m 18s):
You know, I’ve seen people quit, I had a doctor hospital who was a surgeon who had an outcome and she’s now working as call or something. I mean, she had all this training, all of this intense internship, residency fellowship, all of those things and the error that occurred and the way that things happened, it just totally deflated her. And we lost a good doctor because of it to do different work than she was trained for.
Dr. Anthony Orsini (33m 50s):
I think that most non-healthcare professionals don’t realize that when physicians do you get sued, even if it’s frivolous, that it does hurt, right. And affects us towards professional burnout or, and the worst case scenario where you’re quitting medicine. And if the medical error happens, being able to say that, you’re sorry, and apologize. And show that patient that you really cared and you’re compassionate may prevent the lawsuit. But if it doesn’t, it’ll at least help you that you said, you’re sorry, it’s a great point. Right?
Shari Moore (34m 23s):
Our defense attorneys, we have an apology on Oklahoma, but they’re like, I don’t want to keep that out. I mean, if someone EO, if they showed compassion to somebody after an event or whatever, the last thing I want to do is not let other people know that they kept hearing about, you know, they kept hearing about the patient as they were doing it. And just another thing now that you’ve kind of brought up the litigation, getting sued, we have just implemented last July. We implemented a proactive litigation support program where we assign a board member to each of our physicians who receive a lawsuit and the primary goal, they don’t talk, obviously talk about the lawsuit.
Shari Moore (35m 7s):
The primary goal is to educate and have a resource to educate outside of the defense panel outside of their client’s panel, a physician, to educate them on the process of the lawsuit and how it feels to you and what you might be feeling as a physician during that time. And so we’re coming up on a year and, and learning about that and learning a lot of different things that we know that doctors won’t ask for help. If you just lay it out there and say, oh, by the way, we have this, if you need it, give us a call. And so we made the decision to be very proactive with that and to call them and just say, look, if you have questions, here’s my name.
Shari Moore (35m 48s):
Here’s my number. I’m your guy, I’m your gal, whatever. Give us a call and then doing maybe a six month follow up with them throughout the process, because we do have a lot of research about the opportunity for increased error over the, like, it actually goes up and does not get back down to where a regular practicing physician is as far as risk stratification for about two to three years. So your risk of having another medical error after you’ve received a lawsuit goes up and it slowly comes down and you can see spikes in that based in, it looks like when you look at the timing, it’s when they’re getting deposed or when the expert is getting deposed against them and things like that.
Shari Moore (36m 32s):
So that information I think, is really valuable to physicians to understand and look at it from that perspective, instead of saying, you know, you might get kind of sad. You might have depression, you might drink a little bit too much. You might be mean to your kids, whatever, and or your staff, but here’s what actually is why you need to know about what the process is because you’re at a higher risk for having another error.
Dr. Anthony Orsini (36m 58s):
And that’s really important because it affects us. And we know professional burnout is at an all time high, 60% physicians have the highest suicide rate of any profession right now when someone sues you or there is a medical error, we feel terrible about that. And that spike occurs because we’re still thinking about it. We’re not ourselves. Maybe we’re second guessing ourselves. It happens even in the NICU at a hospital where there’s a death, even when there’s no medical error. And it’s just an inevitable death, that nurse, I’m trying to remember the exact statistic, but the nurse, the chance of that nurse, making a medical error immediately after that death is way up because she’s upset or he’s upset.
Dr. Anthony Orsini (37m 39s):
And we need to take care of our doctors and nurses. If we’re going to help this and doctors, as you said, they, you know, it’s been said that we feel like we don’t need any help. And we have this big S on our chest and we can get through it when it’s just not true. So fixing this issue of malpractice and medical errors is going to help the bottom line of medicine. It’s going to help patients for medical errors is going to help doctors and nurses. And I think it’s a topic that we need to speak more out. So thank you. We’re coming to the end now. And we’re going to come to my final question that I ask all my guests title of this is difficult conversations. And so in your career or personal life, what is the most difficult conversation that you’ve had to encounter?
Dr. Anthony Orsini (38m 26s):
And please give us some good advice on how to navigate through that.
Shari Moore (38m 29s):
I’d love to be able to set great advice for it, but as a manager, I think for me, I’ve always actually been pretty comfortable talking to patients if something happened, because I think I believe in the process so much, but for me, the ones that give me the most heartburn are situations where I have someone that I’m either working with or who worked for me, or maybe it is a physician who needs to have some information given to them that might not be the best, the thing that they like to ask. And for me, that’s the hardest. And most of the time, it has nothing to do with the actual tasks that somebody is doing.
Shari Moore (39m 14s):
It’s generally something that has to do with an attitude or a behavioral thing, which is the hardest to me because I’m very black and white person. So what I find is that easiest for me to do is to really try to just identify the behaviors that are objective and to be able to say, you know, I noticed this, and this is unlike you. This is our goal. This isn’t looking at our mission. You know, I hired you because of all of these strengths and I’m not seeing those right now. And in most of the situations, I’ve laid awake, worrying about it. And then they’re like, oh my gosh, you’re so right. This is going wrong at home.
Shari Moore (39m 56s):
I know. And they literally have almost been waiting for me to point it out to them, but those give me the most heartburn because I have such an investment in my staff and the people that I work with and my expectations for how they treat other people, how they do go about their work is they’re very high. I have pretty high standards. And a lot of that is about being a servant leader. And no matter which job you have have told my husband, I don’t know why we’ve been talking about it the other day. I said, but the thing that makes me the most crazy is when someone treats me differently, because I’m the vice president of risk than they treat one of my consultants, or then they treat my administrative assistant.
Shari Moore (40m 44s):
And in the hospital is the same way they treated me differently because I was a risk manager versus now they treated a nurse or how they treated a nursing assistant. I don’t have a tolerance for that because I think we all have a part to play. And I think we all have value in what is the end goal. And so my expectation for people is that they treat everyone with respect and recognize their contribution to whatever the task is, whether that’s at work at home or wherever. So hopefully that answers your question.
Dr. Anthony Orsini (41m 18s):
I think that’s great advice. My father told me at a very young age, he said to me, you’re not better than anybody in this world, but remember, no, one’s better than you either. And I’ve always remembered that. And it’s true that we need to treat everybody like they want to be treated like we want to be treated and how you start those difficult conversations, make all the difference in the world. And you just gave some great advice. Let somebody, as we discussed, when we talk about conflict resolution, you kind of lead them to the water and then they drink. That’s so much better than saying Tony, you’re doing a horrible job in shape up, or you’re out of here.
Shari Moore (41m 56s):
That way. Why are you acting that way? Generally, if you can start the conversation with something, they can’t really argue with that. You said this, I got this email from someone or whatever. It’s just an objective statement.
Dr. Anthony Orsini (42m 11s):
Leave your office as a leader, they could leave your office saying Sherry, she’s a jerk. I hate her. Or they can leave her office and say, I disappointed Sherry. And that is never going to happen again. And that’s the difference between a true leader. And there’s the segue between communication and medicine and the doctor, patient relationship to the leader, teammate relationship. It’s all about communication. So this has been great Shari. I mean, we covered so many topics in such a short period of time, but it’s a topic that everyone needs to hear about and needs to learn about. And I thank you so much for sharing your wisdom with us and hopefully there’s people out there that are going to really understand that.
Dr. Anthony Orsini (42m 52s):
Let me fill up my toolbox now and learn how to reveal medical errors and learn all this. I’m so excited that PLICO is taking a lead in prevention here, instead of just trying to put band-aids on wounds that already happen. So thanks so much for sharing your time with us. We will put all your contact information on the show notes, and we’re excited for everyone to hear this, just to make our attorneys happy. The views and beliefs of this podcast from the guests and the interviewee are both our own and not necessarily the beliefs of our respective companies and institutions. Always got to make the attorneys happy. If you enjoy this podcast, you’d like to get in touch with me.
Dr. Anthony Orsini (43m 34s):
Please go ahead and get in touch with me through the Orsini way.com please subscribe or follow on apple it’s available and almost every single podcast platform. Thank you, please go ahead and download all previous episodes and I’m so excited and I can’t wait for my audience to hear this.
Shari Moore (43m 51s):
Thank you so much.
Dr. Anthony Orsini (43m 52s):
Thanks a lot, Shari, I appreciate it.
Announcer (43m 55s):
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Dr. Anthony Orsini
For More Information:
It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation by Dr. Anthony Orsini
Sorry Works! 2.0: Disclosure, Apology, and Relationships Prevent Medical Malpractice Claims by Doug Wojcieszak