patient safety

Medical Injury Alternative to Malpractice Litigation Continues to Expand Across Mass.

Posted in Malpractice, medical liability reform, patient safety on May 19th, 2015 by Erica Noonan – Comments Off on Medical Injury Alternative to Malpractice Litigation Continues to Expand Across Mass.

Thcommunicatione Massachusetts Alliance for Communication and Resolution following Medical Injury, or MACRMI, continues to increase the numbers of patient cases and sites across Massachusetts and the nation. where health care providers and patients can cooperatively resolve medical injury situations.

MACRMI, formed in 2012, is an alliance of Massachusetts patient advocacy groups, teaching hospitals and their insurers, and health care providers.  Its mission is prompt recognition of – and response to – medical injury, along with appropriate compensation to the patient or family, with the goals of improving patient safety and reducing medical costs.

MACRMI, through its Communication, Apology, and Resolution, or CARe program, has so far handled more than 850 patient cases at eight sites around the state, said co-founder Alan Woodward, MD., MMS Past President and Chair of the MMS Committee on Professional Liability.  More than 75 percent of those CARe cases were resolved by the program and not referred to an insurer.

More than 150 health care leaders, physicians and insurers gathered at the organization’s third annual forum this week at Massachusetts Medical Society headquarters.  Much progress has been made in offering an alternative to the “deny and defend” culture that typically surrounds malpractice cases, said Melinda Van Niel, Health Care Quality Manager at Beth Israel Deaconess Medical Center.

Several more medical providers are preparing to formally enter the program in the coming year, she said.

CARe focuses on communication between patient and doctor after an incident of medical harm. The program also investigates the issue thoroughly and determines if something can be done to prevent the error from happening again in the future.

Over the past year, MACRMI has updated and clarified its guidelines, worked with the National Patient Safety Foundation, and  have produced educational programs  to help guide providers, attorneys and patients through the CARe program.

Leaders said the organization hopes to expand awareness in Massachusetts and broaden its reach on a national level within the next few years.

“CARe is the first step in changing the culture of our institutions,” said Allen Kachalia, MD, Associate Chief Quality Officer, Brigham and Women’s Hospital. Read more about MACRMI here.

— Katherine Schauer


The President’s Podium: A Vote for Vaccines

Posted in Health, Medicine, patient safety, Primary Care, Public Health on September 4th, 2013 by MMS Communications – 1 Comment

If we need any reason to remind our patients about the value of vaccines, all we need do is look around our country and the world. Diseases once thought to be under control, even eradicated, are reappearing with disturbing frequency.

Measles and mumps outbreaks have occurred in Canada, Europe, and the Middle East. Polio has shown a fierce stubbornness, resurfacing in Somalia after six years. The disease has reached Israel, which is re-vaccinating one million children, from Pakistan, one of three countries, along with Nigeria and Afghanistan, where it remains endemic.

Those counties may be far away, but distance no longer offers the protection it once did.  A measles outbreak in Brooklyn earlier this year, brought back by an overseas traveler, is a stark reminder that an outbreak – or epidemic – can be just one plane ride away.

In the U.S., outbreaks have occurred coast to coast. According to the Centers for Disease Control, 2012 was the worst year in six decades for whooping cough with nearly 42,000 cases. The number of measles cases in the U.S., recently highlighted by an outbreak centered in a Texas church whose ministers reportedly questioned the value of vaccines, is on track this year to be one of the highest in 17 years. Mumps is returning as well, as evidenced by more than 100 cases in Virginia.

While immunization rates may be high for children, too many people appear to be losing sight of the importance of vaccines. More states (though our record in Massachusetts has been good) are granting medical and philosophical exemptions from childhood vaccinations, and the medical-conspiracy theorists are still at it – and even given potential platforms to air their misguided notions. ABC Television’s appointment of an outspoken childhood vaccine critic as a co-host of a widely-watched morning show, for example, has rightly caused outrage. It prompted a Boston Globe editorial, saying “the network shouldn’t let her use the show as a platform for her theories. Giving them even a moment’s notice would be a disservice to the public.”

The paper recognized an unfortunate truism: despite mountains of evidence on the safety of vaccines, scare tactics can still work with some people.

The irony – and frustration – of all this is that as more diseases become drug-resistant,  as new ones like MERS emerge, we continue to fight the old ones we can prevent.

The focus on vaccines must also encompass more than children. The vaccine for HPV, the most commonly sexually transmitted infection, has yet to gain widespread acceptance, and more than 50,000 adults die each year from vaccine-preventable diseases and their complications.

CDC Director Dr. Thomas R. Frieden, in urging the medical community to promote vaccinations, said recently that “The doctor is the single most influential factor that determines whether kids get vaccinated.”  It’s true for adults, too.

The message is clear: As with so many other areas in health care, physicians can make the biggest difference, one patient at a time.

The President’s Podium is a new feature that appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   

The President’s Podium: In the Court of Public Opinion

Posted in patient safety, Primary Care, Tiering on August 22nd, 2013 by MMS Communications – Comments Off on The President’s Podium: In the Court of Public Opinion

by Ronald Dunlap, M.D., President, Massachusetts Medical Society

With the constant push for quality, safety, and transparency, the practice of  rating physician performance is becoming as commonplace as the stethoscope in health care.

Insurers have developed tiers; the federal and state governments and private organizations have launched websites. Local and national magazines rate physicians individually and by group practices. Patients can rate their doctors on any number of websites. The focus on ratings has become so widespread that even organizations best known for reviewing restaurants and home services have joined the club.

Some physicians bristle at the notion of such assessments. A few have filed lawsuits in response to negative reviews, and some, in attempting a preventive strategy, have asked patients to sign documents promising not to use any rating websites. This tactic has backfired and not surprisingly, strained the physician-patient relationship.

Like them or not, ratings are here to stay. Some provide useful information; some not so much, merely allowing disaffected patients to vent about the care they think they should have received, how much time they spent in the waiting room, or why they couldn’t talk to the doctor when they wanted. The methodology used by some organizations and the low sample size may also raise questions. Fortunately, most experts will caution patients about such information, advising them to judge the relevance, accuracy, and reliability of the information with extreme care and to use the information as just one of many factors when judging physicians.

To be sure, physician performance is a critically important and complex issue, and MMS has been ahead of the curve. Back in 1999, MMS first developed our Principles for Profiling Physician Performance, which has since been updated. That was followed by a similar document for health plans, and we’ve even provided guidance for patients.

In the end, each patient individually will determine how well his or her doctor is providing care, and that perhaps is the only rating that truly matters. But reasonable patient input and well-constructed surveys can offer a yardstick for measurement, especially with so many changes taking place in health care.

With that in mind, here’s a look at some responses from the MMS’s recent public opinion poll that relate to physician performance:

  • 84% expressed satisfaction with the care they received over the last year. Notably, that’s comparable to the 88% rate of satisfaction in 2004, when we first asked the question. 51% cited quality of care as the biggest reason for their satisfaction.
  • 74% said they have asked their physician for suggestions when deciding where to go for medical care, signaling that the physician remains the most preferred source of information about care.
  • 67% said they would prefer to receive care from a physician; this despite the proliferation of retail clinics and a new state law allowing nurse practitioners and physician assistants to act as primary care providers.

There’s always room for improvement, and while one hundred percent in every category will remain the target, the judgment from our patients again this year is that Massachusetts physicians and health care providers are living up to their reputation for quality care. That’s good news for physicians, and the high level of satisfaction over a decade, in which huge changes have occurred, is especially gratifying. But let’s remember this: the court of public opinion on health care is always in session. And that’s just as it should be.

The President’s Podium is a new feature that appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   



A Culture of Safety and “Doctor as God”

Posted in patient safety, Physician Health on April 12th, 2013 by MMS – Comments Off on A Culture of Safety and “Doctor as God”

By Steve Adelman, MD

Brigham and Women’s Hospital in Boston, one of the nation’s best, has become a leader in yet another area: Creating a culture of safety that improves patient care by helping physicians and other health care personnel view medical errors as learning opportunities.  The Boston Globe reported on the initiative in a front page article earlier this week.

Most often, preventable medical errors stem from imperfect and flawed systems and workflows, and are not a result of a single individual’s bad judgment or poor care decision. The growing culture of safety at the Brigham emphasizes fixing the system, not on disciplining the individual whose mistake was a consequence of a flawed workflow.

The culture of safety is actually a counterculture. It runs counter to a deeply embedded culture that puts physicians on pedestals – let’s call that culture the “Doctor as God” culture. In the “Doctor as God” culture, some members of the public, not to mention goodly numbers of our patients, family members and friends, imbue us with super-human powers.

In fact, countless physicians work wonders every day. We help enormous numbers of people – with our technical ability to fix most medical problems, with our listening skills, and with our ability, above all, to relieve suffering by interacting in helpful ways with our patients and their families. One of the unfortunate pitfalls of medical practice is that some physicians buy into the “Doctor as God” culture themselves. It’s one thing to understand that patients in distress sometimes put you on a high pedestal because doing so helps them to get through a very difficult and stressful situation.

But when the doctor loses his or her humility and begins to feel that he or she belongs on a pedestal, that’s when things can start to get funny. Believing that you can do or say no wrong is dangerous. It can cause friction with colleagues, co-workers and patients, and may contribute to bad medical decision-making that leads to medical errors.

So let’s own and acknowledge the fact that each and every physician is human; even the greatest of healers. Let’s pursue our calling with an attitude of competence, compassion and humility. And let’s enthusiastically embrace the culture of safety that strives to perfect systems of care for the betterment of all.

Dr. Adelman is director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society. For more information, visit Opinions expressed here are his own, and do not necessarily reflect those of the Massachusetts Medical Society or Physician Health Services.