Über die Autorin bzw. den Autor

James R. Woods, M.D., is the Henry A. Thiede Professor and chair of the Department of Obstetrics and Gynecology at the University of Rochester School of Medicine, Rochester, New York.

Fay A. Rozovsky, J.D., M.P.H., is senior vice president in the Healthcare Practice of Marsh Inc. She has more than twenty years experience as a health care risk management consultant and attorney.

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What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics will help physicians and other health care professionals improve their communication skills with patients and their family members. Written by James R. Woods, a perinatologist, and Fay A. Rozovsky, an attorney, risk management professional, and authority on informed consent, What Do I Say? explores how to explain risk to patients, how to obtain patient consent, and how to talk with patients when adverse events occur.

"There has been increased evidence placed on the patient's right to know and malpractice litigation in obstetrics continues to soar. It will be a great resource for health care risk managers, obstetrical clinicians, attending physicians, residents, and nurses."
― Robin Maley, B.S.N., M.P.H., president, Maley Healthcare Strategies

"It is unusual to see a book like this by authors with [the] kind of experience and interest that James Woods and Fay Rozovsky possess. This book has the potential to become the definitive text on informed consent and disclosure of adverse events."
― Nancy A. Moree, R.N., M.A., C.N.A.A., Patient Safety Officer, Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, New Jersey

"By the authors placing emphasis on the need for ongoing two-way
communication between the patient and the caregiver, this book becomes an
important and very useful resource for health care professionals."
― Don M. Nielsen, M.D., senior vice president, quality leadership, American Hospital Association

• Explains consentas a foundation of the caregiver-patient relationship
• Explains the legal context for disclosing bad news
• Outlines the practical issues associated with OB consent

Aus dem Klappentext

What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics will help physicians and other health care professionals improve their communication skills with patients and their family members. Written by James R. Woods, a perinatologist, and Fay A. Rozovsky, an attorney, risk management professional, and authority on informed consent, What Do I Say? explores how to explain risk to patients, how to obtain patient consent, and how to talk with patients when adverse events occur.

"There has been increased evidence placed on the patient's right to know and malpractice litigation in obstetrics continues to soar. It will be a great resource for health care risk managers, obstetrical clinicians, attending physicians, residents, and nurses."
— Robin Maley, B.S.N., M.P.H., president, Maley Healthcare Strategies

"It is unusual to see a book like this by authors with [the] kind of experience and interest that James Woods and Fay Rozovsky possess. This book has the potential to become the definitive text on informed consent and disclosure of adverse events."
— Nancy A. Moree, R.N., M.A., C.N.A.A., Patient Safety Officer, Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, New Jersey

"By the authors placing emphasis on the need for ongoing two-way
communication between the patient and the caregiver, this book becomes an
important and very useful resource for health care professionals."
— Don M. Nielsen, M.D., senior vice president, quality leadership, American Hospital Association

• Explains consentas a foundation of the caregiver-patient relationship
• Explains the legal context for disclosing bad news
• Outlines the practical issues associated with OB consent

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What Do I Say?

Jossey-Bass

Chapter One

The health care industry is like a ship being tossed by high waves in the middle of a severe storm. It is being buffeted by angry and often distrusting patients, regulators, and legislators calling for rigorous scrutiny and payers demanding evidence-based quality care. At the same time, litigation-minded lawyers have fomented a wave of malpractice. The result has been a contracting of insurance carriers willing to write health professional liability insurance coverage. Those who are left in the field are demanding very expensive premiums for less coverage than was available only a few years ago. In the malpractice cases that go to trial, juries are sending a signal that the health care industry must transform itself into a quality-driven, accountable endeavor or be prepared to take the consequences in large damage awards.

To understand why there is so much emphasis on patient communication in the health care field, it is important to reflect on the drivers of this change: the change agents found in the government, accreditation, consumer, and payer sectors. Although many may not welcome this pressure for change, the result may be a health care system better prepared to partner with patients in the delivery of quality treatment and services.

THE FEDERAL PERSPECTIVE

In 1999, the Institute of Medicine (IOM) issued a landmark report that seemed to capture these shifting winds of dissatisfaction and distrust. In To Err Is Human: Building a Safer Health System, the IOM noted that the American health care industry kills an estimated forty-four thousand to ninety-eight thousand patients every year through medical error-related events. The report pointed out that many of these deaths were preventable. Subsequently, a number of federal entities known as the Quality Interagency Coordination (QuIC) Task Force made their own recommendations in response to the IOM report. This QuIC report, Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact, delineated one hundred action items for the federal government to take to rectify the situation. In part, the government strategy focused on institutional accountability, leadership, and communication.

After the QuIC report, the Agency for Health Care Research and Quality (AHRQ; formerly known as the Agency for Health Care Policy and Research) took on a leadership role among federal authorities committed to patient safety. AHRQ has funded a variety of studies and research. One particular report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices, reflects AHRQ's research commitment. Prepared by the University of California at San Francisco (UCSF)-Standard Evidence-Based Practice Center (EPC), it focuses on evidence-based patient safety practices.

Working with the National Forum for Quality Measurement and Report, better known as the National Quality Forum (NQF), a partnership of private and public sector entities, the EPC developed a definition for a patient safety practice: "a type of process or structure whose application reduces the probability of adverse events resulting from exposure to the health care system across a range of diseases and procedures." This definition encompasses communication skills and consent to treatment. Indeed, the report contained a discussion about informed consent and the need for research on the topic in conjunction with patient safety practices.

The Food and Drug Administration, the Conditions of Participation for Hospitals in Medicare and Medicaid Patients Rights Standards, and federally sponsored reports addressing the issue of patients rights all point to the need for strong communication processes. Involving the patient in the decision-making process is viewed as a key ingredient to successful medical treatment.

THE STATE GOVERNMENT PERSPECTIVE

At the state level, the move toward patient safety has been demonstrated by legislative initiatives geared toward reporting serious adverse events or patient deaths to databases in the belief that collecting such information will be useful in holding health care entities accountable for their performance. As distinguished from voluntary reporting methodologies, the mandatory reporting procedures found in some states are at times linked to fines and penalties, and the format is tied to public disclosure.

Some innovations have also occurred at the state level to facilitate reporting of adverse events without fear of disclosure of this information in medical malpractice litigation. The idea is to create an atmosphere conducive to the examination of adverse event information with a view to process improvement in patient safety. Examples of this approach include evidentiary use laws in Oklahoma, Minnesota, and Louisiana. However, these laws are more the exception than the rule.

In addition, at the urging of the IOM in To Err Is Human: Building a Safer Health System, consideration is being given to a rethinking of health professional licensure at the state level. The intent is to consider a variety of methodologies, including periodic relicensure.

The IOM report also emphasized the need for institutional accountability on the part of health care facilities. Indeed, To Err Is Human: Building a Safer Health System explored the idea of enterprise liability, that is, holding health care entities legally responsible for the errors and omissions of nonemployee health professionals who had been accorded staff privileges. According to this concept, the health care entity could not avoid liability even when it contracted out delivery of health care services to physician groups for such departments as radiology or emergency medicine. Following the logic of this enterprise accountability theory, the hospital could be held negligent for a substandard consent to treatment on the part of a staff physician.

Thus far, only two states have clearly adopted the legal theory of enterprise liability. In neither instance was consent the issue. Rather, it was the matter of substandard delivery of emergency treatment. However, at least one court has examined the idea of enterprise liability for negligent consent. The point is that consent and the communication process underlying it may well be the basis for holding a hospital responsible for the negligence of a staff doctor. This type of liability exposure gives impetus to those who are trying to improve provider-patient communications and discussion of negative treatment outcomes.

THE ACCREDITATION PERSPECTIVE

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the accrediting body for hospitals in the United States. In addition, it accredits nursing homes, integrated delivery systems, managed care organizations, and other health care organizations. The accreditation process is about quality of care, safe environments of care, and patient safety. It requires health care organizations to demonstrate compliance with standards developed for guiding health care services. Surveys are done to compare performance with the standards, and depending on the outcome, a health care entity may or may not receive a grade that is comparable to similarly situated facilities. Facilities that are in noncompliance...