Governance, Mission, Growth
Apology in Medicine: When Ethics and Self-Preservation Collide
Sapheneia: Providing Clarity in Oncology Treatment One Patient at a Time
Apology in Medicine: When Ethics and Self-Preservation Collide
By Cat Vasko
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| Healing Words: The Power of Apology in Medicine, Second Edition, is available for $25 using order code HWPM-07 by calling (877) 223-6866 or visiting www.jcrinc.com. |
Healing Words: The Power of Apology in Medicine, Second Edition, a new book released by Joint Commission Resources Inc, a nonprofit affiliate of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Oak Brook, Ill, looks at one facet of the burgeoning malpractice problem in medicine not often mentioned on 60 Minutes—remorse. According to author Michael S. Woods, MD, five Rs are involved in apology: recognition, regret, responsibility, remedy, and remaining engaged. Physicians who apologize for their mistakes, Woods argues, provide better care, promote true healing—and, to sweeten the deal, are less likely to be sued.
“The first question is, do you disclose the untoward event to the patient?” notes Leonard Berlin, MD, chairman of the Department of Radiology at Rush North Shore Medical Center, Skokie, Ill; professor of radiology at Rush Medical College, Chicago; chairman of the American College of Radiology’s ethics committee; chairman of the Radiological Society of North America’s professionalism committee; and a member of Axis Imaging News Editorial Advisory Board. “Now, of course everyone agrees: You should and you must. [JCAHO] says to disclose all errors, and if you talk to any ethicist or look at the AMA code of ethics, certainly that’s a clear statement. … But notwithstanding the moral and ethical side, the fact of the matter is that the rate of disclosure is low. Everyone’s afraid of a malpractice lawsuit.”
Woods addresses the issue of liability by noting, “The current system of deny and defend makes doctors sitting ducks. Doctors and hospital administrators are left to wonder if a process server bringing bad news will follow an unanticipated outcome. That’s no way to live. If a mistake occurs, doctors have to ask themselves one question: Would it be better to handle this situation on my terms, or have it fought out by high-priced attorneys in front of a jury of strangers?”
Berlin acknowledges the verity of this perspective, but not without a caveat. “There are those who say an authentic apology is not only an admission that an error has been committed and it’s my fault, but that I want to offer restitution,” he says. “That’s where the gray area is. If you’re talking about an institution where everyone’s salaried, it’s a lot easier for someone representing the hospital to go to the patient and say, ‘We can offer you this or that.’ In the private sector, where most of us practice, everyone is with a different insurance company, so it’s a different story. Who’s going to start talking?”
At RSNA 2006, Berlin participated in a discussion panel on the subject of apology, along with a plaintiff’s lawyer, a defense lawyer, and a claims manager for an insurance company. “The claims manager pointed out a very interesting aspect of this,” Berlin says. “Although he’s in favor of saying you’re sorry, he says [that as a physician, you need] to understand that if you go so far as to tell a patient that it’s your fault, and if you go so far as to offer compensation, you could be violating the contract with your insurance company.”
Woods cites compelling evidence that apology works—such as the case of the Veterans Affairs (VA) Medical Center in Lexington, Ky, which went from having one of the highest malpractice claims totals in the VA hospital system to one of the lowest simply by consistently admitting errors to patients, and offering restitution where appropriate. By circumventing the legal system, the hospital saved money while building better patient relationships.
But Berlin again cautions that in the private sphere, things can be a little more complicated. Without the power to offer financial recompense for errors, radiologists are left to stumble alone across a rocky legal terrain. “Pretend I go to a patient and say, ‘I misread something on your chest film 6 months ago and missed a tumor. I’m very sorry.’ If a malpractice suit does ensue and there’s a trial, that statement can be admitted as evidence.” Berlin further explains that 19 states have passed extrajudicial immunity statutes to encourage physicians to apologize—”But if I said, ‘I’m sorry, it’s my fault,’ then it can be admitted. Except for Colorado, all these statutes say that an expression of sorrow cannot be admitted, but an expression of fault can.”
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In an environment increasingly hostile to medical errors, where malpractice litigation costs are skyrocketing, what’s a practitioner to do? Though Woods’ book paints a pretty picture of trusting relationships between patients and medical professionals, Berlin is skeptical: “Aside from malpractice suits, doctors fear it could lead to a loss of referrals, and it could affect their privileges, even their licensure. The fact is that many doctors still feel that it is better not to admit it—or better yet, blame it on someone else if you can.”
Maybe that’s why Woods writes in his introduction, “I believe most physicians long to do the right thing. When one of our patients is in pain, suffers an unanticipated outcome, or fails to respond to treatment, our hearts tell us to empathize, to reach out. Unfortunately, our profession has become increasingly deaf to the calls of the heart. Only we can change this situation.”
Sapheneia: Providing Clarity in Oncology Treatment One Patient at a Time
By Rich Smith
Of all the radiology innovations credited over the years to Patrick E. Sewell, MD, possibly the most intriguing is one currently wending its way through the FDA approval process: a software program that makes an image shot at 10% of the normal amount of radiation appear as though it had been captured at full dose.
Sewell is pioneering this product in partnership with CAD Sciences, White Plains, NY. The idea behind it is to reduce patient and—more profoundly—practitioner exposure to radiation, says Sewell, developer of five minimally invasive image-guided interventional radiology techniques and a pair of devices used in conjunction with them.
However, having the ability to create full-dose images from a fraction of the radiation also dramatically reduces energy consumption needs, which opens the door to the miniaturization of equipment. “Theoretically, you could have an imaging device that runs on 120-volt, single-phase power from a household electrical outlet,” Sewell explains. “That implies the possibility of truly portable, handheld imaging devices, or even those powered by batteries or solar panels. Alternatively, you could use this software to take an image using the full dose of radiation and then enhance the output significantly beyond the limits of today’s best machines.”
Offering Clarity
Sewell’s contribution to this software’s testing and refinement has been taking place in Jackson, Miss, at a 15,000-square-foot, four-story freestanding interventional radiology center—christened Sapheneia LLC—that he and business partner Rick Mancilla jointly established in 2005. Their enterprise’s mission is to radically alter the way oncology care is provided in the United States and around the world.
“Today’s oncology treatment model suffers a number of shortcomings,” contends Mancilla, who serves as Sapheneia’s CEO. “The most troubling of these is the lack of clarity provided to patients and their families with regard to cancer—what the disease is all about, what the progression involves, and what all of their treatment options are, not just one or two.”
Sapheneia strives to give patients clear insights (the name Sapheneia is the Greek word meaning clarity) by offering extensive education that begins with a thorough evaluation conducted by Sewell. “Patients I see for the first time spend a good 11¼2, 2 hours with me,” he says. “I give them that much time so they can have a full and complete opportunity to ask every question they have and be educated properly about their disease.”
Also, the discussion of treatment options does not favor one specialty over another. “Our interest is in devising the best, most aggressive treatment regimen,” Sewell says. “That can involve ablation, or it can involve radiation therapy, conventional surgery, and chemotherapy.”
Building Toward Capacity
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| Rick Mancilla (left) and Patrick E. Sewell, MD, have created Sapheneia, a clarity-providing oncology care center in Jackson, MS. |
Cancer evaluations and treatments provided by Sewell are conducted under the auspices of Sapheneia’s Medical Minimally Invasive Therapy Institute, which just began seeing patients in November 2006. It is understandable, then, that case volume is currently below capacity—even though the Institute is outfitted with CT, ultrasound, fluoroscopy, a C-arm unit, and a state-of-the-art integrated RIS/PACS. “We’re capable of handling six ablation cases daily and upward of 60 patients requiring other interventional radiology services, including angiography, veinography, endovascular laser procedures, and placement of dialysis PIC lines,” Mancilla explains. “To date, the patients we’ve treated have presented with cancers of the lungs, kidneys, liver, uterus, and neck.”
The Institute’s portion of the Sapheneia building is every bit as elegant as it is comfortable. “Ours is not a typical physician office,” Mancilla says. “It is an extremely reassuring place with an exceptionally tranquil atmosphere to help our patients be free of stress. We see to it that arriving patients are greeted by a concierge whose job it is to attend to their every need. Then, they are escorted into our waiting area, which is actually an art gallery—it features a water-wall and a one-of-a-kind Murano Venetian hand-blown glass chandelier. There, we exhibit paintings and sculptures by important local artists, many of whom are or were Sapheneia patients.”
Given the quality of the setting and the fact that Sewell is a top ablation specialist who lavishes attention and time on patients, it should come as no surprise that treatment at Sapheneia is pricey. Since most payors, including Medicare, refuse to pick up the tab, the majority of patients pay out of pocket. To that end, Sapheneia has set up a charitable foundation to financially assist patients of meager means.
Patients typically come to Sapheneia after being diagnosed elsewhere. Some are referred by a cancer specialist, others by a primary care physician. Still others self-refer, having discovered Sapheneia online (www.destroycancer.org) or by tuning in to an international radio program—carried on more than 100 stations and boasting 50 million listeners—that mentions Sapheneia frequently on its Sunday health-awareness show. The facility’s mention is voluntary on the show’s part; Sapheneia does not purchase air time. Sewell explains that the coverage is “because so many listeners have been evaluated and successfully treated.”
Far-Flung Growth
Entrepreneurial-minded Mancilla—who played a key role in launching LumenIQ Inc, a developer of software that improves the visual detection of digital data imagery—says he and Sewell intend to spread the Sapheneia model far and wide. “Other doctors and companies in other cities here and abroad are interested in duplicating what we’re doing,” he reveals. “We already have a site in Ventura, Calif, and are looking to open one in New York City; we also have a presence in the Swedish cities of Stockholm and Linköping, and we’re talking to a number of facilities across Sweden that are interested in becoming Sapheneia oncology clinics.”
The various Sapheneia locations are not cookie-cuttered, but they do share many features in common. The most pronounced of these is the education component. “Patients coming to Sapheneia may or may not undergo treatment from us,” Sewell admits, “but they always will receive clarity so that wherever they ultimately go to receive treatment, they can have the confidence that it is the right treatment for them.”
Rich Smith is a contributing writer for Axis Imaging News. For more information, contact .
