January 10, 2010

USA: Is ‘Sorry’ the Hardest Word in Health Care?

. NEW YORK, NY / The New York Times / Business / January 10, 2010 Slipstream Is ‘Sorry’ the Hardest Word in Health Care? Christophe Vorlet By Natasha Singer AH, the thorny and seemingly never-ending topic of employee error and corporate misconduct: How does your company handle it? Deny and defend? Disclose and apologize? With the recent bombing attempt on a flight to Detroit and the deadly bombing attack on American intelligence agents in Afghanistan, the question of how to publicly account for system failure is, of course, playing out in government. But major industries also have their share of breakdowns to account for. Consider health care. Does working for a hospital or a drug maker mean never having to say you’re sorry? Even a decade ago, according to physicians, it was standard practice for many doctors and hospitals not to inform patients about medical errors. Now an increasing number of leading medical centers are taking a different tack and encouraging doctors to apologize to patients for mistakes and to explain what went wrong. Doctors say that such accountability can help patients feel more cared for and empowered, as well as enhance the reputation of the doctor and medical center as honest brokers. Although one might assume that apologizing exposes hospitals to increased litigation, a few medical centers, including the University of Michigan Health System, have reported that the approach has reduced malpractice suits. Apologizing isn’t popular among drug makers, however. And in our litigious country, C.E.O.’s are understandably gun-shy about teeing up a costly lawsuit by issuing an apology that a court might later construe as an admission of guilt. So even though two leading drug makers last year paid massive fines to settle charges that they had illegally marketed certain drugs for unapproved uses, they did not use the word “apologize” in their public statements. Last January, the drug maker Eli Lilly pleaded guilty to a misdemeanor and paid $1.41 billion to settle criminal and civil charges that it improperly marketed an antipsychotic drug for elderly patients with dementia, potentially putting them at risk. In September, Pfizer paid $2.3 billion to settle criminal and civil charges that it had illegally marketed an anti-inflammatory drug and other products. One of its subsidiaires, the Pharmacia & Upjohn Company, pleaded guilty to a felony related to the anti-inflammatory drug. After its settlement, Lilly issued a press release saying, “We deeply regret the past actions covered by the misdemeanor plea.” (In response to a reporter’s query, Marni Lemons, a spokeswoman for Lilly, said, “We think that is an apology.”) Similarly, Pfizer’s statement said, “We regret certain actions taken in the past.” (Christopher Loder, a Pfizer spokesman, said last week, “We have publicly acknowledged our conduct and taken full responsibility.”) Each drug maker also said it maintained comprehensive corporate compliance policies and had instituted additional measures as part of corporate integrity agreements with the government. If we lived in a litigation-free world, it might be easier for drug makers to go further than this. (On the other hand, without the threat of legal penalties, they might also consider themselves less accountable.) But putting litigation aside for the moment, what about a company that finds the strength to directly apologize to physicians and patients whose ethics or well-being may have been undermined by questionable marketing or potentially risky drugs? The difference between apologizing and simply offering a “regret” may seem semantic. Yet some ethicists and analysts say that different words do, in fact, reflect divergent approaches to accountability. A company that openly apologizes does more than merely take public responsibility for its actions — it also signals to its own employees that certain practices are unacceptable, analysts say. And, they add, a company expressing regret may not be accepting blame. After all, you can regret an event, like an earthquake or a hurricane, in which you played no role. “Companies use ‘regret’ as a way of avoiding accountability,” said Dr. Carl Elliott, a professor at the Center for Bioethics at the University of Minnesota. “You regret something that happened, not something that you did.” In one of the few pharmaceutical mea culpas of last year, the chief executive of Genzyme in Cambridge, Mass., wrote a letter to patients with two rare genetic conditions, apologizing for a medication shortage that occurred after the company shut down a manufacturing facility because of viral contamination. The letter acknowledged that the company hadn’t maintained a sufficient inventory of the drugs. “We certainly failed to meet the needs of these communities,” says Jamie Manganello, Genzyme’s associate director of global patient advocacy. “I don’t think there was a choice not to apologize.” Indeed, in light of a Harris poll last month that reported that Americans trust drug makers only slightly more than they trust tobacco or oil companies, contrition still could have a public relations upside for drug makers. The poll was published at the end of a year in which a series of government investigations and lawsuits showed how some drug makers paid leading physicians and patient advocacy groups, engaged in misleading marketing, supported ghostwritten articles in medical journals and tried to squelch doctors’ concerns about drug safety. Although the industry has recently changed its approach to some of these practices, industry watchers say drug makers could advance their cause by also apologizing. “The companies should be saying, ‘We did lousy; we did not put our best foot forward,’” says Doug Wojcieszak, the founder of the Sorry Works! Coalition, a consultant group in Glen Carbon, Ill., that trains medical professionals in the art of apologizing. OPENLY apologizing also has the potential to turn a problem into a teachable moment for employees, thereby preventing a repeat occurrence, says Paul Levy, the chief executive of Beth Israel Deaconess Medical Center in Boston. In 2008, a surgeon at his hospital mistakenly operated on the wrong side of a patient. The doctor and other hospital personnel apologized. And Mr. Levy publicly dissected the event on his blog, called “Running a Hospital.” The medical profession, he says, was initially hesitant to embrace contrition. But, he says, “as in any field, once you have a few leaders do it and the world doesn’t end and, in fact, is made better, then people tend to follow.” [rc] Copyright 2010 The New York Times Company