Class Notes
Living Humanely at a “Brutal Interface” Tim McDonald ’79 is applying the Gentleman’s Rule to the issue of hospital safety, restoring trust between doctors and their patients, and saving lives and millions of dollars in the process. —text and photo by Steve Charles THE OMINOUS TITLE OF DOCTOR AND ATTORNEY.
Tim McDonald’s talk—“The Brutal Interface Between Law and Medicine”—signaled a grim presentation about a crisis where his two professions meet. A sort of medical/legal apocalypse. Instead, McDonald offered a remedy—the College’s Gentleman’s Rule. The chief safety and risk officer for health affairs for the University of Illinois Medical Centers, McDonald ’79 described to Wabash prehealth and pre-law students in November how he applies the Gentleman’s Rule to the issue of patient safety, restoring trust between doctors and their patients and saving lives and millions of dollars in the process. His program has been so successful that he recently received a grant to expand it to 5,000 hospitals nationwide. But when he first proposed the idea, McDonald said, “They thought we were out of our freaking minds.” MCDONALD GRADUATED from medical school in the early 1980s and into a watershed moment in anesthesiology. In 1982 the ABC News program 20/20 had reported that 6,000 people would die or suffer brain injury that year due to human error in the administration of anesthesia. In response, the American Society of Anesthesiologists created the Committee on Patient Safety and Risk Management, whose first report led to improved technology for monitoring patients’ breathing and other changes in the practice. The result: In 1982, 1 in every 2,000 patients was harmed while under anesthesia; in 2011, that number was 1 in every 300,000. Still, hundreds of thousands of patients die each year because of medical mistakes, McDonald told students. “That’s absolutely unacceptable, but we’re not going to get any better as long as we have this brutal interface between law and medicine—as long as no one talks about the mistakes because they’re afraid of being sued. “To improve patient safety you need a system of transparency, and the tort system discourages transparency. It kills the conversation that needs to happen. It’s not uncommon for lawyers to tell doctors when something goes wrong, ‘Don’t talk to anybody about this.’” McDonald cited the aviation industry’s improvement in passenger safety as an example for medicine to follow. “In aviation they realized that if they were going to get safer, they needed people to talk about what happened when things went wrong and learn from it. Aviation has gotten safer, in part, because of this 66
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transparency. Medicine hasn’t gotten there yet, and that’s critical. We have good people in medicine; we know it’s the system that’s broken.” McDonald has received $13 million in federal grants to fix that system, “looking at different ways we can respond when harm occurs, how we can learn and improve safety, how we can mitigate the impact of the tort system.” The best way he’s found so far: Live humanely and follow the Gentleman’s Rule. “Being sued sucks,” McDonald said, “and that prospect is a huge barrier to being honest with patients when a mistake is made. And we’re not going to get better if we don’t talk about it.” The turning point for McDonald came when the chief operating officer of the hospital he’d first practiced at came to the University of Illinois hospital for surgery. The operation was successful, but she died six weeks later of treatable leukemia because doctors didn’t check a blood test that would have revealed the disease. “I went to our legal department and said, ‘Can we please reach out to this patient’s family, say we’re sorry, talk about what happened?’” The legal department said, “No.” “So we get sued, pay $325,000 to defend the indefensible, settle for millions, and don’t learn anything—now, that’s the brutal interface between medicine and law! This happened in 2000, I’m three years out of law school, and I’m looking at this and thinking, This is nuts! Why are we deferring to the legal system when we hurt people? Why shouldn’t we proactively address these issues so we can learn from them and deal with this harm we’ve done?” So McDonald and his colleagues began “to look at the benefits of being honest. “We came to realize that we could get safer, and maybe patients or their families would forgive us, and maybe we wouldn’t get sued as much.” McDonald said a Michigan hospital had begun reaching out to families in this manner and had achieved extraordinary results. McDonald has instituted a similar program at the University of Illinois Medical Centers. “I was actually able to get the University of Illinois to agree to the Gentleman’s Rule—we will conduct ourselves at all times, in the medical center and away, as gentlepersons and responsible citizens. We will live humanely: We will be honest with our patients when our care hurts them.”