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31st Annual Robert M Heavenrich, MD Endowed Guest Lecturer
Thursday, October 14, 2021 31st Annual Robert M. Heavenrich, MD Endowed Guest Lecturer
G Gregory Yanik, M.D.
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LeLand and Elaine Blatt, Professor of Oncology Clinical Director of the Pediatric Blood and Marrow Transplant Program Michigan Medicine, University of Michigan – d his Fellowship of Pediatric Hematology‐Oncology at Children’s Hospital Medical Center, Cincinnati, OH. Dr. Yanik went on for Post‐training; Professor of Pediatrics, Division of Pediatric Hematology‐ Oncol nd Marrow Transplant Program and co‐directs the Cell Therapy/CAR‐T co‐directs / CAR‐T program at Michigan Medicine. He currently serves as the chair for the Cell Therapy Scie Yanik has served as a co‐investigator and co‐author of the FDA CAR‐T licensing trial for tisagenlecleucel
– “Pediatric Oncology: Lessons Learned from my Colleagues.”
– – “Pediatric Oncology: Less ts”
research tradition of “bench to bedside”, i.e. translating medical breakthroughs 2. On our bone marrow transplant unit at Mott Children’s Hospi om our patient’s possess. Tuesday, September 25, 2021 RSVP by Tuesday, September 25, 2021, to Liz Stanton at stanto52@msu.edu ~ (517) 355-3308
gnates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in ty, pediatric residents, medical students and community physicians.’
Department of Pediatrics and Human Development
DOs and DON’Ts for Discussing Face Masks and COVID-19 Vaccinations with Patients and Visitors
“Do facemasks work?” “Should I get the COVID-19 vaccine?” These are just two of the many questions and concerns physicians and other health care providers frequently encounter when discussing face masks and COVID-19 vaccines with patients. The following guidance is intended to provide some suggested practices for physicians when engaging patients in these discussions.
DO encourage patients to “mask up” indoors and receive the COVID-19 vaccine.
Due to the rapid spread of the highly contagious Delta variant, patients and visitors should be encouraged to follow guidance from the CDC and other public health organizations which recommend that individuals wear a face mask indoors in public spaces, regardless of vaccination status. In addition, based on CDC and FDA guidelines, patients should be encouraged to receive the COVID-19 vaccine to help build protection from the virus. Physicians should counsel patients, who are not candidates for the vaccination due to medical conditions, on risk mitigation strategies, such as wearing face masks indoors, social distancing and hand washing.
DO use effective communication that is tailored to the patient.
Physicians should consider using words which will better resonate with each patient. For example, when discussing the benefits of COVID-19 vaccination, explain the safety of the vaccine and the benefits to the patient and his or her family. Physicians should also be transparent with patients, such as discussing potential side effects of the COVID-19 vaccine or the effectiveness of cloth vs other types of face masks in preventing the transmission of COVID-19 indoors or in crowded places. Physicians should avoid using judgmental language against individuals with face mask or vaccine concerns, which could negatively impact the patient’s trust and the overall physicianpatient relationship. In addition, sharing facts about face masks and the COVID-19 vaccine, as opposed to personal opinions, may be more effective.
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DO continue to implement COVID-19 policies and other infection prevention measures recommended by the CDC and MDHHS.
The CDC continues to recommend that medical practices and facilities use additional infection prevention and control practices during the COVID-19 pandemic, including, but not limited to, telehealth visits where medically appropriate, screening patients and visitors entering the facility for signs and symptoms of COVID-19, and implementing source control measures, such as face masks.
If a patient or visitor objects to or refuses to comply with the practice’s COVID-19 policies, such as refusing to wear a face mask, physicians should ensure its policies include a protocol for explaining the CDC’s guidelines for health professionals, which may be different from mandates or guidelines for individuals, and that a patient must comply with the policies while inside the facility. If necessary and appropriate, the patient’s appointment may be rescheduled to a telehealth visit, or the patient may be referred to another physician for treatment.
DON’T routinely terminate patients who refuse to receive the COVID-19 vaccine.
It has been reported in the media that some physicians are refusing to treat unvaccinated patients. In other instances, some physicians have declined to treat children based on the parent’s vaccination status, although the American Pediatric Association advises against refusing to treat pediatric patients based on parental vaccination status or position. Generally, a physician is legally free to determine whom to treat and to end the physician/patient relationship with appropriate advance notice. Until consensus develops on any potential ethical, licensing or liability risk exposures that physicians could face by routinely declining to treat individuals who are unvaccinated or due to the vaccination status of others, physicians should consider making treatment decisions based on the facts and circumstances of each situation.
DO implement a process for handling patient claims of medical exemptions from the practice’s COVID-19 policies applicable to patients.
Medical practices are generally considered places of public accommodation and must comply with the federal Americans with Disabilities Act, as well as, Michigan’s Persons with Disabilities Civil Rights Act, when enforcing the practice’s own COVID-19 policies. Physicians need to have a process to address requests by patients and visitors for exemptions from the practice’s face mask mandate or similar policies based on medical grounds and to assess whether or not reasonable accommodations are possible. Physicians should
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not assume that an unmasked patient or visitor cannot medically tolerate a face mask or comply with other COVID-19 policies, but physicians are permitted to accept the patient or visitor’s verbal representation to that effect. Best practices advise to not request medical documentation from the patient or visitor to determine whether the patient or visitor has a disability warranting a reasonable accommodation.
DON’T provide face mask or vaccine exemption letters or documentation to patients which are not medically necessary.
Several media sources have reported on several physicians who have been disciplined by various state medical boards for issuing medical exemptions to patients without an objective medical basis for the exemption. Some physicians individually oppose policies which mandate face masks or COVID-19 vaccinations. Other physicians may empathize with patients who may be negatively impacted by their refusal to comply with mandatory COVID-19 policies, such as a patient who may face termination from employment unless the patient receives the COVID-19 vaccine. Regardless, physicians should not attempt to help patients circumvent COVID-19 policies applicable to patients by drafting letters or other documentation regarding the patient’s medical condition that is false or misleading.
Prevent, Communicate, Document: Medical Malpractice Data Helps Us Manage Risk
David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group One way to think of reducing malpractice risk is to consider the three-P model: (1) Prevent adverse events, (2) Preclude lawsuits from being brought if adverse events do occur, and (3) Prevail in lawsuits when a suit cannot be precluded. All three Ps can be informed by a careful examination of medical malpractice data. Not only do malpractice claims provide a richer source of data than typical hospital-based adverse event investigations, but because malpractice data has a direct correlation to large sums of money, it is easier to use claim-related findings to drive tangible, system-wide improvements to patient safety that no one wants to pay for.
Prevent, Preclude, Prevail
Prevent adverse events. “We can’t fix what we can’t see,” says Dana Siegal, RN, CPHRM, CPPS, Director of Patient Safety Services for CRICO Strategies. The Doctors Company employs CRICO’s coding taxonomy when we analyze medical malpractice claims. When considering this first P, it’s important to remember that some adverse events may represent a fairly large percentage of the events named in lawsuits, but a small percentage of the events in a hospital, most of which do not result in a lawsuit. Having robust malpractice data allows risk managers to better understand which adverse events are highly associated with claims and the factors that led to those events.
Preclude lawsuits with good communication. When we analyze medical malpractice claims across specialties and settings, communication gaps crop up again and again. Those gaps can stem from medical team members miscommunicating with each other or with patients or families. While the former may result in an adverse event (see the first P: Prevent), the latter may result in a lawsuit. A patient’s desire to pursue litigation after an adverse event frequently derives from a misunderstanding about possible outcomes. If your institution participates in a disclosure program, follow it carefully when responding to adverse events. A swift, compassionate, effective response to a patient’s needs in the aftermath of an adverse event or undesirable outcome is both ethically superior and practically advantageous for all parties, when compared to a lawsuit as the likely alternative. Prevail when there are lawsuits via documentation. While undesired outcomes - even those that fall within the realm of a known complication for the treatment or procedure - may motivate patients to sue, it is often poor documentation that motivates a plaintiff’s attorney to take a case. In addition, defending a case is easier for defense attorneys when there is clear, concise, and timely documentation, especially when the adverse event occurred despite optimal care.
Prevent, Communicate, Document
Experience has taught us that patients may bring suit either in the presence of actual medical error or in their perception of medical error. Either way, through medical malpractice data, we have an opportunity to learn how to prevent the next claim.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
