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Guest Editorial MARCH 2007
Apologies All Around
Ronald T. Burkman, MD
In this monthÕs issue of
The Female Patient, James H. Hughesian, JD, and
I discuss the role of apology in managing a patient who has experienced a bad outcome (Communication and the Dissatisfied Patient, Part 2,
pp 31-33). The more widespread use of this approach has been endorsed by many leaders in medicine as a means of promoting honesty with our patients. At the same time, however, I see no similar trend on the part of others toward apologizing to physicians and patients for the wrongs committed against us.
For example, where is the apology from the legislators who continue to fail to enact meaningful tort reform? Our current medical system spends the
majority of its funds on ÒadministrativeÓ costs, including liability costs, fees for plaintiff and defense attorneys, and various experts. A totally revamped approach could reduce such costs, redirecting more funds toward those experiencing an adverse outcome. Adopting a legal system that minimizes the litigation process would also reduce the elusive costs associated with the practice of defensive medicine.
Moreover, where is the apology from the managed care companies who complicate the practice of medicine, confusing and irritating our patients with the reams of paperwork they require? Our administrative staff spends hours chasing down referral forms and authorizations, as well as trying to explain their necessity to patients. To collect for services rendered in the office, practitioners must use a coding process that reminds one of the menu in an old-fashioned Chinese restaurant; you need one from column A and two from column B to get your reimbursement. And despite all these efforts, reimbursements still lag behind the increasing costs of practicing medicine. As an aside, I find it somewhat sad to note that the most popular continuing medical education courses offered by the American College of Obstetricians and Gynecologists deal with coding rather than topics that directly affect patient care. I realize that knowledge of these complex systems is necessary for survival in todayÕs medicine, but it is still disconcerting to find that such matters have become a critical part of medical practice.
As a final example, who in the Bush administration is going to apologize for the rather cynical appointment of Eric Keroack, MD, to head the Department of Health and Human Services Office of Population Affairs? This agency funds birth control, pregnancy tests, and other health services for an estimated 5 million poor women annually. However, Dr Keroack is no longer board-certified, and has espoused a number of theories and practices that do not conform to the agencyÕs mission. For example, he has refused to distribute contraception at the clinics he founded—even to married women. On their Web site (A Woman's Concern, http://www.awomansconcern.com), these clinics espouse
fundamentalist Christianity and an antiabortion platform, stating that abstinence is the only acceptable form of Òcontraception.Ó Is limiting access to contraception and allowing women to experience an unintended pregnancy less demeaning?
Dr Keroack has even suggested that people who have had more than one sexual partner have a diminished neurologic capacity to experience loving relationships—an interesting (but wacky) theory unsupported by any notable science. Unfortunately, his appointment does not require confirmation. Physicians can only hope that whatever damage he does will be minimal, until the current administration is replaced.
So as physicians expand the use of apology in medicine, we can only hope that those who impose their legislative and corporate wills on us will be likewise as considerate. In the same spirit,
I apologize to you, the reader, if I have in any way offended you.
Ronald T. Burkman, MD
Associate Editor
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