[December 27, 2013]

PMSLIC Offers Physicians Ten Tips for Disclosing Unanticipated Outcomes

PMSLIC Insurance Company, a wholly owned subsidiary of NORCAL Mutual Insurance Company, offers physicians ten tips for coping with the challenge of talking to a patient about an unexpected outcome of care. These tips serve as risk management guidance for all physicians but especially for those looking for advice in the wake of Pennsylvania's new Benevolent Gesture Medical Professional Liability Act. This Act, an "apology law" that took effect in Pennsylvania on Dec. 24, permits physicians to say, "I'm sorry" for unexpected outcomes without the fear of their words being used later to prove negligence. However, the protections are not without limitations.

Pennsylvania's new apology law gives physicians some comfort that their expressions of apology will not later be maneuvered into confessions of liability in state courts. After adverse outcomes of care, doctors often participate in demanding and uncomfortable disclosure conversations. The new Pennsylvania law gives physicians a little more protection as they continue to care for, inform and offer closure to patients and families.

"It is important for physicians to stay informed of change to the law and how it affects their medical practice. Our team of risk management specialists monitors the changing medical and legal landscape and is available to help our policyholders understand its intricacies and evaluate risks, " Dustin Shaver, vice president of risk management said.

To read in greater detail on strategies and recommendations offered by PMSLIC risk management specialists, the full article is available for download on the PMSLIC website (www.pmslic.com).

Ten Risk Management Tips for Disclosure Discussions

1. When there has been an adverse outcome of care, analyze the situation to establish the facts about what happened. Knowing the facts will help you determine what kind of communication is appropriate: an expression of empathy for an unexpected result or an apology for a mistake.

2. Remember that the medical environment is supportive of disclosure of the facts associated with adverse outcomes. The thought that you are complying with an accepted ethical principle can encourage you as you perform the difficult task of disclosure.

3. Plan disclosure discussions so they will be as beneficial as possible to the patient and family: deliver understandable, detailed information in a comfortable, private setting.

4. Seek assistance if you have concerns about conducting a disclosure discussion. Members of a hospital's risk management department or patient safety team or a risk management or claims representative from your professional liability company can help!

5. During the disclosure discussion, calmly listen to and acknowledge the patient's and family members' responses. Remember that those affected by an adverse outcome may need to express anger, fear, or sorrow and to have these emotions validated.

6. View a disclosure discussion as an education opportunity. As a physician, you educate patients about medical concepts almost every day. In a disclosure discussion, then, you are carrying out a well known task: explaining the details associated with a patient's current condition so that the patient can better comprehend his or her situation.

7. Don't blame other providers for an unanticipated outcome. Tell patients and family members that you can only comment on your own care but that you will refer any questions they have to the disclosure team so that they can get answers.

8. Use your informed consent process as a way to truly teach patients about the risks and benefits of a particular procedure or treatment being considered. Informed consent is a communication interchange that enhances the patient's understanding about the possible outcomes of care.

9. Make clear, detailed, straightforward notes in the patient's medical record about an adverse event and a subsequent disclosure discussion. This documentation will best benefit the patient's future care.

10. When errors in care are identified, analyze how they happened and make changes that will improve patient safety in the future.

The NORCAL Group of Companies

NORCAL Mutual Insurance Company, PMSLIC Insurance Company and Medicus Insurance Company, members of the NORCAL Group of companies, are medical professional liability insurers providing protection to more than 28,000 physicians, healthcare extenders, medical groups, hospitals, community clinics and allied healthcare facilities in the nation. The companies share a group rating of "A" (Excellent) by A.M. Best for their financial strength and stability.

NORCAL Mutual is based in San Francisco, CA (News - Alert), and operates in California, Alaska and Rhode Island. PMSLIC is based in Mechanicsburg, PA, and operates in Pennsylvania and Delaware. Medicus is based in Austin, TX, and is licensed to sell medical professional liability insurance in 37 states across the nation.

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