An Interview with Dr. Tom Gallagher
As is customary, we sat down with the 2012 HOPE Award winner, Dr. Tom Gallagher, and asked him to reflect on his work. Below is a transcript of that interview.
What are your personal reflections on winning the 2012 HOPE Award?
It is an incredible honor to have won the 2012 HOPE award. We are seeing enormous positive momentum developing around improving the response to patients and providers following medical injuries. I believe that the positive recognition that the HOPE award provides will significantly accelerate these developments and help lead to meaningful change.
Were you surprised? Why?
The HOPE award generates considerable attention, and I know that the review committee was considering multiple outstanding nominees. It was definitely a pleasant surprise to learn that I was selected as this year's recipient.
Along the lines of Bob Wachter’s (keynote speaker at MITSS’s annual dinner) “surprises/epiphanies” theme, what, if any, have been your surprises/epiphanies over the course of your work?
When I started a decade ago conducting research on how physicians communicate with patients about errors, I thought I might be making a bad career move. I wondered if physicians and institutions would quickly adapt to these new recommendations for transparency, and start sharing information with patients about errors much more readily. Such a rapid change in practice would have meant that we needed to change the direction of our research, since the problem had been "solved.” My experiences as a clinician with the difficulty talking with patients and families about errors should have been a clue to me that major change would be much slower in coming. The reality is that ten years later, effective disclosure to patients is still the exception rather than the norm. (See Dr. Gallagher's acceptance of the HOPE Award.)
I am also surprised that, despite all the rhetoric about the importance of patient-centeredness in healthcare, how our systems for responding to patients who are injured by healthcare have continued to focus primarily on the needs of healthcare providers and institutions and much less on truly meeting the needs of the affected patient and their family. The vast majority of patients who are injured by healthcare receive no compensation for any financial need that result from their injury. Yet rather than considering this problem under compensation of injured patients, organized medicine has focused its attention on reducing malpractice premiums and frivolous lawsuits. Bringing all the key stakeholders together, including patient advocates, malpractice insurers, plaintiff and defense attorneys, and regulators, will be critical to reaching consensus about what a truly patient-centered approach to accountability following medical injury would look like.
How do you see the role of the patient in your work? Do you see a more significant role for patients in the future? Why? How?
For the response to medical injury to be truly patient-centered, patients in general and the organizations that represent them must play a much more active role going forward. Patients can contribute to a much fuller understanding of what the appropriate response to medical injury can look like, how to engage patients in understanding the root causes of adverse events, and working with regulators such as state medical boards to create Just Cultures in healthcare. Many patients are choosing to work within the healthcare system as patient advisors and navigators, helping patients feel comfortable in voicing concerns that they may have about their care and facilitating effective responses. Over time, there may be an important role for trained patient advisors to support injured patients during the disclosure and resolution process, especially those injured patients who may have difficulty obtaining representation from a traditional medical malpractice plaintiff attorney.
What is the most important thing(s) you have learned along your journey?
The success of work in this area relies on strong relationships and creative collaborations among all the stakeholders. Over time, this is helping to create environments where we can overcome our natural inclinations to not disclose medical errors to patients or our colleagues, and to want to punish those we see as responsible for causing harm.
Where do you see your work going in the near/distant future?
We will be focusing heavily on working towards developing and testing radically patient-centered models of accountability following medical injury, approaches that emphasize disclosure, resolution, and collaborative learning.
Do you have any specific plans for the $5,000 cash prize?
There are lots of costs associated with conducting research and education around improving the response to medical injury that are not typically covered by grant funds--the generous cash prize will be invaluable in supporting these expenses.