Admitting fault and saying sorry can be hard for anyone, but for an American doctor whose medical error has killed a patient it can mean a lawsuit that ends his or her career.
Doug Wojcieszak recalled the way doctors literally ran away from his mother in the hallway of the hospital after their fatal misdiagnosis of his brother Jim in 1998.
Advertisement"It's a cultural thing in medicine, that initial instinct to pull back and to sever the relationship with the patient or the family and clam up as a way to mitigate or reduce the chance of a lawsuit," he told AFP.
His brother had walked into hospital complaining of chest, shoulder, neck and stomach pains -- classic signs of a possible heart attack.
Because he was only 39, and "a big, strong guy", the doctors automatically assumed he was having some kind of stomach problem.
When his parents brought him back the next day in excruciating pain, they had a closer look but critically mixed up his X-rays with those of his father, who had undergone tests in the same hospital months before.
"His blood test is showing heart distress, but they are looking at my dad's charts showing no blockage, so they misdiagnose my brother with a bacterial infection to the heart," explained Wojcieszak.
Doctors plied Jim full of antibiotics for the next two days and by the time they realized their error it was too late -- he died during emergency open heart surgery as they tried desperately to unblock four major arteries.
The tragedy was hard for the family to take, but their grief was compounded by an ensuing cover-up that meant they had no choice but to sue. Eventually, struggling to find any kind of closure, a settlement was reached in 2000.
"My parents had to relive the death of their first-born son for two years," said Wojcieszak.
Five years later he founded The Sorry Works! Coalition to unite fledgling projects that encouraged doctors to disclose mistakes, apologize and offer compensation.
His coalition argues that solving the malpractice crisis is not a legal problem, involving complex reform of America's tort laws, but simply a customer service one.
President Barack Obama might agree as he has instructed Health Secretary Kathleen Sebelius to examine such projects as part of a 25-million-dollar program to curb medical malpractice lawsuits.
"We're thrilled that it's part of the national debate," said Wojcieszak, who dismissed the existing system as a "never-ending fight between lawyers and doctors, pointing fingers and yelling and screaming".
Malpractice reform has stalled in the United States for decades, even as studies indicate more than 100,000 people die each year as a result of an estimated 15 million preventable medical errors.
In high-risk specialities such as neuro-surgery and obstetrics, doctors also fork out hundreds of thousands of dollars a year on insurance premiums to offset the risk of professional error.
Obama surprised many when he promised a new look at the complex issue as part of his ambitious health care overhaul, defying the conventional wisdom that malpractice reform is only a Republican cause.
Republicans, backed by the doctors, argue that caps should be imposed on the amount of damages patients can receive, but Obama told the American Medical Association in June such measures would be unfair to those wrongfully harmed.
He is leaning more towards special courts and programs like Sorry Works, and Sebelius has been instructed to award grants from early 2010 to states and hospitals that find innovative ways to address the malpractice mess.
Tim McDonald, chief safety officer at the University of Illinois Medical Center in Chicago, finds himself at the vanguard of this movement.
His doctors maintain communication with families when things go wrong, conduct full investigations of any errors and then apologize, when appropriate, before fast-tracking cases for possible settlement.
Since the program launched in 2006, the culture of admission has helped doctors introduce new monitoring procedures for sedation, develop a better system to prevent blood clots, and even find equipment left inside patients.
"We had a case where we left a sponge behind and totally changed our process for how we prevent those," McDonald told AFP.
"There are certain patients at risk for leaving things behind and we actually get X-rays on them even when we think we've accounted for everything in the operating room. We've found several objects in those patients by having changed that process."
Susan Steinman, director of policy at the American Association for Justice, the leading organization for trial lawyers in the United States, is also on board.
"I think that 'Sorry Works' in particular has a lot of merit and has been used successfully by several large university hospitals," she told AFP.
"It's a good program because not only does it look at ways to reduce litigation costs, it looks at ways to reduce medical errors."
Insurers were very skeptical at first as they thought disclosure would increase the number of lawsuits.
"That hasn't happened," said McDonald. "Instead, we've been able to show we've prevented certain kinds of events from happening again."
For Wojcieszak, the Sorry Works revolution can't come soon enough.
"Patients and families can live with screw-ups, even fatal screw-ups so long as someone's got the integrity to stand up and say: 'I made a mistake, let's talk about how I can try and make this right by you.'
"This is simply just taking care of people and reaping the benefits."
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