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Full Disclosure: The Search for Medical Error Transparency - Trailer

Directed by Lawrence Kraman - Produced by Dillon Poole - Executive Produced by Shelley Kraman Written by Lawrence Kraman and Steve S. Kraman, MD ...

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I have been an outspoken representative of the patient harmed population since 2008 when my wife was left 24/7 dependent after an elective surgery, falsified records including 3 professors, and 3 residents.. All condoned, and supported by Risk Management at that medical university. In this trailer, we have a problem from the start. Any transparency program that does not START in the public presentation of healthcare, (their web sites, etc) also the informed consent, .. can not be expected to be credible AFTER HARM. It will continue to be about increasing profits and never improve outcome in the future. The systematic corruption of morals is simply too entrenched starting in our universities. Without patient's free-open access to the clinical audit log, and audio/video of provider/patient interactions, this conversation is doomed from the start. Why risk managers and doctors DO NOT want patient access to the very things to prove care WAS appropriate is obvious. Yet again...Intentional deception from the start. It is simply non-negotiable to continue hiding the very thing to prove, or disprove medical record credibility. Just look at University of Michigan Leepfrog rating.. A rating, yet post-op death rate is worse than average.. wow, not learning much are we Rick?
Just thinking out loud...Cameras would sure add the first grain of integrity to post harm conversations.. ? no//shellyskalicky.blogspot.com/p/if-surveillance-techniques-are-used-to.html
Thanks for responding, and yes please do look at those patients, puling the audit log may show a pattern of deeds neither of us want to talk about in public. (just saying)Duke University Hospital may want to look at their preventable death rate numbers too, Their post-op death rate is even worse than yours..(over 13% are left to die post-op)  The big number for Duke is Patients there are consistently dying from lack of oxygen..  hmm.. The misdiagnosis rate of often over 10% yet never documented or admitted to.. no autopsy.. questionable record integrity.. better have a look see there too. (Don't need another 60 minutes expose.. or   ....maybe they do.)Im sure ya catch my driftLast but not least:Of course I know there are excellent, dedicated providers out there, problem for them is they are dependent on the whole spectrum of providers. I do understand the quandary these providers are forced to work with.Providers with drug/alcohol addictions, drug diversion, altered records, cheating on exams, bla, bla bla..The best providers, and yes, medical students can never truly become great in this environment.  No university can ever produce providers of integrity from an environment that does not reward integrity.Hope to share more thoughts in the future, one day, maybe on the subject of the audit report..Tip of the hatDanny
+Danny Long I'll have someone look into those numbers and apparent causes, thanks.  Those kinds of statistics are kept and reported regularly and I'm not aware of a rash of post op clots.  But, I will look into it for sure.  You're completely correct about the importance of the record's integrity.  We opened a patient portal more than a year ago which allows our patients to access the charting quickly, communicate with caregivers and check the veracity of the record.  I saw my own doctor a few months ago and caught a mistake right away that made a difference in a scheduled follow-up interval.  We transitioned to a completely new electronic record and there is a lot to fine-tune.  It WILL always be limited though - no record will offer 100% of the patient's experience which makes it more important than ever for patients to be vigilant for themselves and unfortunately, the record is used for so many functions - especially financial - that like anything else, if it's a jack of all trades, it will be a true master of none.  It's an important tool, but it's just a tool and won't substitute for a truly close, trusting relationship in which the patient's best interests are at the center of things.  I am sad to read your cynicism though - a great many dedicated people are working very hard and despite the fact that most bad things get routed through my office, I see miracles every day, not the "storm of horrors" you refer to.  I hope you find the right relationship to restore some trust - not blind trust because we each should feel a sense of self-determination about our health care - but I can tell you that we've seen a decided and conscious improvement in the quality of our patient relationships and that improvement is directly related to folks like you who speak out.  Thanks again for your note.Sincerely,Rick Boothman
Hi Rick, thanks for your thoughtful response.. As far as the "A" grade, and the post-op death rate problem I pointed out.. Well, from a farmers view, it looks like your patients are dying post-op of blood clots, even though you "say" your taking the steps to prevent blood clots.???I am not all that smart, but with just that information, I would walk on down to post-op and see for myself if what you say your doing, is being done. (tried and true, "Trust but Verify")Anyway, my larger concern about disclosure is the credibility of the medical record to start with.  The old "trust me, .. Im a doctor" days are over, have been for a long time.  The public and HHS are now expecting patient acess to the clinical audit log/report to make sure both sides have credible records to discuss, or testify to.The hospital that first is known to establish unquestionable integrity and credibility with audio/video and audit log reports will be marked in history as the one who turned the tide in this storm of horrors.Danny Long.
Hi Mr. Long,Thank you for your comments.  Re your paragraph, "Any transparency program that does not start . . ."  I think you are right - one of the most important lessons we've learned is that the patient relationship is based on trust, that transparency is an important - indispensable -vehicle for trust, and the relationship should be infused with that from the beginning, not simply used later only when things go wrong.  Patient relationships not only need to be open, they need to be focused around the patient.  Informed consent is a great example:  it's not enough to make sure the patient is educated about options and risks, but we need to help patients and caregivers tailor clinical care choices around the individual patient's needs, social resources, risk thresholds, etc. Health systems, clinical leaders, administrators are all buffetted by a variety of bewildering, oftentimes competing, and too-often, conflicting drivers, incentives, fears, threats . . . In the arena of medical injury, I believe Medicine historically has been preoccupied with the perceived financial threats to such a degree that it's come at the expense of clinical improvement.  Turfing tragic clinical outcomes to lawyers even before we make honest assessments of the quality of care has not only exposed both patients/families AND clinical staff to the awful experience of litigation needlessly, that decision prioritized perceived financial risk and inhibited and chilled robust clinical improvement, placing future patients at risk while we too often defended care that should not have been defended. Medicine is an inherently risky business and caregivers and health systems cannot control all the risks.  It IS true that health care providers can do everything reasonably and unanticipated outcomes still occur.  In my career, I've seen at least two cases in which children died from a routine prescription of an antibiotic for their first ear infections. So a prinicipled, honest evaluation is critical before deciding on a response to patients who have been harmed. Defaulting to defensiveness and in turn, relying entirely on the litigation game too often abandoned the more important mission of patient safety and continual improvement. What gets missed in the dialogue around the subject of Mr. Kraman's film is that in our model, transparency is not a claims management strategy - it may be the most public face of our model, but our goal is to be the safest hospital we can be - and the way we respond to unanticipated, unplanned clinical outcomes matters - it matters a great deal.  We can either be defensive or open.  We can either be principled - which means we have to honestly confront our failiings and yes, sometimes it means we communicate conclusions to patients that they don't want to hear, too - or we lapse right back into the deny-and-defend mode and cut off efforts to improve. As for statistics, numbers, Leapfrog ratings - I'm no expert, but I am aware that those sorts of things are much more complicated than it might seem.  If a hospital's cardiac surgery unit specializes in complex cardiac cases and the hospital across town routinely refers those patients but keeps the easier ones, it may not be inconsistent that post-op death rates are higher at the same time Leapfrog ratings are an "A".  These numbers are dependent on so many variables like statistical methodology, skewed self-reporting, splitting hairs in definitions, case mix, etc.  I know enough to know I don't know the answers to that - only that the whole world of health care statistics is imperfect and drawing conclusions from single lines of data is not a very good way to judge a complex place like the University of Michigan Health System.As for the rest, we are not perfect and despite working hard over 13 years to be principled about medical injury, we have our detractors, doubters, skeptics.  All we can do is to put our heads down and do the best we can, knowing that we never want to lose sight of the larger picture.  I mean no disrespect when I say this, but the patient whose injury comes to my attention is not the most important patient in the equation at that moment in time;  the most important patient is the one who has not been hurt yet.  And that is the moral imperative that must drive our response.  We can't be focused on improvement without honesty and transparency; I believe we can't engage in deny-and-defend publicly, but value transparency behind the scenes. Do we always get it right?  Absolutely not. Do we always please patients AND caregivers, of course not. Does the public have a right to be skepical?  Absolutely. But the best we can do is to put our heads down and work hard to be honest because that is the only way we can serve both patients AND caregivers to focus on the most important goal:  to prioritize our patients and their health care as our FIRST priority.  And though there are skeptics and detractors who question us, it is only through our body of work, our track record that we have a chance to dispel the justifiable skepticism. I am sincerely sorry that you come to this community through personal tragedy - but I am grateful for thoughtful people like you who question and push.  I disagree with your last observation - at the University of Michigan we HAVE learned a lot over the past 13 years and we HAVE improved a lot and we HAVE seen tangible evidence of culture change, but we do have a long way to go, too. I'm sorry for the epistle  and I'm quite sure that despite my remarks many doubters will remain and some may even weigh in on this with skepticism  but I can say this with certainty:  it would be a mistake to doubt our sincerity in this. It's not only the right thing to do for injured patients and families, it is the very best way we can support our health system and all the amazingly dedicated people who work in it every day.  Rick  
All of these issues are covered in the complete film.  I hope you get a chance to see and then comment.  Just as you cannot tell a book by it's cover, neither can you review a film by it's trailer.
My father-in-law died a week after a colonoscopy due to a perforated bowel. It took almost a week for the hospital to acknowledge that something was wrong and by that time his body was so ravaged by infection that nothing could be done. We were told a couple of hours before he died that the infection came from a perforation in the bowel that most likely occurred during the colonoscopy. We did not pursue negligence or malpractice with the hospital as no matter what they did, nothing would bring back my father-in-law. The damage had been done to our family and no amount of "compensation" would ever make it right. Not to mention the last thing we wanted to hear was "sorry". This did cause me to stand up more diligently and be more aggressive in making sure that my family receives the care they deserve. I am much more vocal now if I believe something is wrong. I urge everyone to stand up for your family member when it comes to medical care. Be the advocate! Thank you Dr. Kraman for the work you are doing for full disclosure. It is nice to know that someone out there cares and believes that the patients and families have a right to know if there is a problem. 
Thanks Linda for your comments and story.  I'm Lawrence Kraman, director of the film and Steve's brother and I share your feelings that more can be done to be proactive when it comes to medical error.  

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