Disclosing MRSA rates: What should you say?

Risk managers advises open disclosure

A recent article in The Seattle Times tells the tale of a woman who inadvertently learned she had methicillin-resistant S. aureus (MRSA) while in the hospital from a nurse making an offhand comment. Since then, that woman, Jeanine Thomas, has been pushing for further disclosure from hospitals on MRSA.

Rick Boothman, JD, chief risk officer for the University of Michigan Health System, says open disclosure and conversation is critical in dealing with this issue. If what he says is true and Thomas had learned about her diagnosis in a different way, she could have left the hospital feeling much better about her care.

"Patients are far more forgiving than we give them credit for, but you've got to give them a chance to understand," he says.

He relates a situation that he frequently sees in dealing with patients at discharge who refuse to leave. "I almost always start out by saying to them, 'What do you want to stay here for? This can be a very dangerous place. It's a collection of very sick people, and there's only so much you can do to prevent the spread of infection and very bad bugs.'"

Historically and continually, he says, the medical community has not done a good job in informing people about the problems with resistant infections at hospitals. "So we're great at trumpeting advances, but we're not very good, and I'm not sure why, about informing the public of how difficult it is to render the care that we render, whether it's complications like infection or other problems. So sensitizing the public to the difficulty of these issues is an important step," he says.

Putting things in context for patients, and the public, is important to both mitigating your risk for liability and to providing good and compassionate patient care. It is human nature, he says, to try to put things together and make a conclusion, "to make sense of what happens to us." If you don't talk openly with patients, he says the likelihood that they "will put it together in a way that is both inaccurate and contrary to your interests" is much greater. "If you don't give them the tools to have a deeper and more accurate understanding, they make the best with what they have."

Doctors, without support, should not be expected to talk one on one with the patient because it's simply too emotional, he says. At Michigan, professional staff are available for help 24/7.

"We are fully committed to this notion that ultimately we serve ourselves, our staff, our institution better through honesty than we do covering things up. And that's really the goal," he says. "Because once someone's hurt, and I don't mean to minimize their problem, but the problem's already happened, and the best we can do is our best to make it right. The very best thing we can do is make sure nobody gets hurt again."