Health Affairs: N A R R A T I V E M A T T E R S
The Rest Is Silence
Hospitals and doctors should beware of what can fill the space of their silence after a loved one's death.
by Michael Rowe
PREFACE: Doctors are told in medical school and in residency that maintaining good relationships with patients is important for good clinical practice. They also are taught that connecting on a human level to patients and their families can help to prevent lawsuits over real or perceived medical error. Medical error may not be entirely preventable, but how doctors communicate about it is something that physicians and hospitals have the power to change. Even as hospitals work to build better systems to reduce error rates, human communication problems persist. Michael Rowe, who lost his teenage son after complications from a liver transplant, tells us how lack of expressions of compassion from doctors after the boy's death-rather than medical error per se-led him down the path toward legal action. Carol Levine recounts the error that permanently disabled her husband years ago and that to this day defines their lives. She followed through with a lawsuit against the hospital that committed the error but explains why money alone is not enough to give her peace of mind about what happened. The tough situation that doctors face when their patients die is described by pediatrician W. Richard Boyte, who sheds light on why doctors often shut down emotionally in such circumstances and why doing so is harmful to patients and to the physicians themselves.