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If something goes wrong when taking care of a patient in your ED, you may have a public relations nightmare to deal with besides a bad outcome and medical or legal issues, warns Norman J. Schneiderman, MD, FACEP, chief of staff at the emergency and trauma center at Miami Valley Hospital in Dayton, OH.
Here are ways to manage the media after a misdiagnosis occurs:
• Respect the patient’s right to privacy.
Information about a patient’s condition or treatment should not be released to the press without getting permission from the patient, says Gregory L. Henry, MD, FACEP, vice president of risk management for Emergency Physicians Medical Group in Ann Arbor, MI.
Avoid answering probing questions by raising the issue of privacy, says Stephen Colucciello, MD, FACEP, assistant chair and director of clinical services for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC. "Make the privacy comment right off the bat," he suggests.
Explain that the medical care of every individual is a private matter and not for public discourse, says Colucciello. "If somebody is going to talk to the press about a medical error, then it can be the patient," he says.
• Have a planned response when talking to a reporter.
Make your point first regardless of what question they ask, Henry advises. "You are going to be portrayed in a sound bite for 11 or 12 seconds, so never put out anything that is juicy and bad upfront," he says.
Never repeat a negative, says Henry. "For instance, don’t repeat the term misdiagnosed,’ he cautions. "It doesn’t matter what you say or do at that point. All they have heard is that one word."
In general, avoid discussions with reporters about medical errors, says Colucciello. "Don’t admit guilt to the press," he advises. "Tell them, we’re looking into it, we want all the facts, our goal is to give the highest possible care to all patients. Explain that there are privacy issues."
• Use one spokesperson.
Only one person should deal with reporters about a specific incident, Henry recommends. "The media should always be referred to the person who is going to handle it," he says. "That could be a physician or the chief of the department. It must be a person who understands the bigger picture, not a nurse or a tech."
Tell reporters, "All statements about care of Mr. XX will be handled by this doctor or administrator," Henry advises. "When President Reagan was shot, only one doctor spoke to reporters, except at a press conference, when the same doctor mediated and directed questions to the surgeon," he notes.
A clinical spokesperson should be "out front" for the hospital, says Steven J. Davidson, MD, MBA, chair of the department of emergency medicine at Maimonides Medical Center in Brooklyn, NY. "A PR spokesperson can provide background and respond to questions, but statements and press conferences must be conducted by a lead hospital clinician, such as the ED director," he explains.
• Consider calling a press conference.
If reporters latch onto a high-profile case and misinterpret the care you provided, a press conference might be helpful, says Schneiderman. "If you feel the case was diagnosed properly, that excellent care was given, and there was no untoward effect, you may want to call a press conference to straighten that out," he suggests.
For example, in the case of the former President Ford, who was diagnosed with a sinus infection but returned hours later with stroke symptoms, a hospital spokesperson could explain that you often can’t make a diagnosis based on early signs of stroke and point out that the former president is doing very well, Schneiderman says. (For additional information on the case involving former President Ford and treatment of VIPs, see ED Management, November 2000 and August 2000.)
• Be proactive with PR.
If you become aware that a patient is later given a different diagnosis, be aggressive in reacting, says Schneiderman. There are ways to do this without admitting you made a mistake, he suggests.
"You can say, I heard that the day after we treated you, you went to another ED and they diagnosed you with a stroke. I was surprised and concerned, because I thought we had done a thorough evaluation,’" he suggests.
At that point, you can gauge the patient’s response, says Schneiderman. "The response may be I plan to talk to my attorney.’ You can respond by saying, That is your option, but I wanted to see how you were feeling,’" he advises.
Being proactive may prevent more media involvement, says Schneiderman. "You may prevent an incident from being blown out of proportion," he notes.
For more information about public relations, contact:
• Stephen Colucciello, MD, FACEP, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232. Telephone: (704) 355-6116. Fax: (704) 355-7047. E-mail: email@example.com.
• Steven J. Davidson, MD, MBA, Department of Emergency Medicine, Maimonides Medical Center, 4802 10th Ave., Brooklyn, NY 11219. Telephone: (718) 283-6030. Fax: (718) 283-6042. E-mail: firstname.lastname@example.org.
• Gregory L. Henry, MD, FACEP, Emergency Physicians Medical Group, 2000 Green Road, Suite 300, Ann Arbor, MI 48105. Telephone: (734) 665-2467. Fax: (734) 995-2913. E-mail: email@example.com.
• Norman J. Schneiderman, MD, FACEP, Emergency Administration, Miami Valley Hospital, One Wyoming St., Dayton, OH 45409. Telephone: (937) 208-2051. Fax: (937) 208-6033. E-mail: njschneiderman@ mvh.org.