Building Rapport

That prescription-drug info from the pharmacy can fall short

The LA Times has reported that the legally required type of medical information given out by pharmacies is not doing the job of communciating risk.

Researchers at the University of Florida found shortcomings in the written information for on “directions for use” and “comprehensibility/legibility”.

They wrote: “Many leaflets failed to meet the minimum requirements, such as provision of a complete list of absolute contraindications, and more than half lacked specific directions that would allow patients to manage problems. Because CMI [consumer medical information] was the sole written information dispensed, some patients had no information about the risk of lactic acidosis associated with metformin or related warning signs or action steps. The high reading level required to comprehend the presented information and the inadequate formatting suggest additional shortcomings.”

Drugstores are for ‘One-Document Solution’ for patient information

The National Association of Chain Drug Stores says pharmacy and consumer groups should collaborate with the government to develop a “one-document solution” for information provided to patients regarding prescription drugs.

NACDS submitted its letter in response to an August 9, 2010, article in the newspaper that was critical of such information. NACDS President and Chief Executive Officer Steven C. Anderson says:

“Pharmacy is working with the government to help provide enhanced user-friendly information to patients about their prescription drugs. The National Association of Chain Drug Stores submitted a Citizen Petition to the Food and Drug Administration (FDA) in June 2008. Seven additional organizations, including other pharmacy and consumer groups, joined in the petition.

“The petition requests FDA guidance describing the parameters for a voluntary, FDA-approved, concise, plain-language document for patients. Such a format could consolidate and replace the multiple written communications pharmacies must now distribute to patients.

“This ‘one-document solution’ could harmonize multiple documents that arise from different FDA-imposed legal requirements or information interpretations, and from different offices and constituencies within FDA.

The Los Angeles Times article is available by clicking here http://www.latimes.com/health/boostershots/la-heb-prescription-information-20100809,0,3840303,print.story

The Wall Street Journal report “The Informed Patient” starts with this unsurprising info:
“Informed consent may be the biggest misnomer in medicine: Studies show that most patients don’t read the forms they sign before undergoing surgery or medical treatment. More than half of those who do read the forms don’t understand them, and only a quarter of forms include all of the data patients need to make an informed decision.”

There is a movement afoot to make it possible to apologize for your actions without being considered to admit that you have done a wrong with legal consequences:

1

Apology Act of B.C., May 2006

http://www.leg.bc.ca/38th2nd/1st_read/m202-1.htm

first in Canada, several in US states

2

Since mandatory apologies provide little comfort, they are seldom ordered by adjudicators. Yet Ombudsmen receive sacks of mail saying: ‘I just wanted an apology, I’m not so interested
in compensation.‘

3

Doctors Advised: An Apology a Day Keeps the Lawyer Away

The Associated Press

“Say you’re sorry when you hurt someone. The medical world is finding that childhood lesson a surprisingly powerful way to head off malpractice suits, especially if the apology comes with an upfront settlement offer. Since encouraging its doctors to apologize for errors, the University of Michigan Health System’s annual attorney fees have dropped by two-thirds, and malpractice suits and notices of intents to sue have fallen by half, says a former trial attorney who launched the practice there…

While the number of settlements would probably increase, lawsuits and sky-high jury awards would decrease, said Doug Wojcieszak, a public relations consultant whose victims’ rights group proposed “Sorry Works.”

Apologies and upfront financial offers could mean the difference between settlements costing thousands of dollars and drawn-out malpractice lawsuits costing millions in attorney fees and jury awards, Wojcieszak said.

The idea for “Sorry Works” came from an honesty policy the Veterans Affairs hospital in Lexington, Ky., adopted in 1987 after two big malpractice cases cost the hospital over $1.5 million.

Dr. Steve Kraman, then the hospital’s chief of staff, said he helped create the policy as an alternative to the traditional “shut up and fight” strategy. The center’s liability costs subsequently dropped below those of comparable VA hospitals, he said.”

4

In the medical/legal field: movement news at The Sorry Works Coalition

http://www.sorryworks.net

5

Legislating apology in the context of medical mistakes

Apologies fall into two discrete categories: expressions of sympathy or benevolence (eg, I’m sorry you are hurt) and expressions of accountability and remorse (eg, I’m sorry I hurt you)…

6

Medical honesty is the best policy:article describing apology policy