Microbiology: Study Adds Carbs to Immune Cell Menu Public Health: How Doctors Might Curb Malpractice Claims Genetics: Junk DNA Yields New Kind of Gene Health Care Policy Largest International Mental Health Survey Finds Widespread Illness, Checkered Treatment Technology: Advanced Device to Probe Atomic Structures, Build Knowledge, Novel Therapies Medical Education: New Clerkship Takes Longer View of Clinical Care Student Research: Dental Students Publish First Issue of Student Research Journal Diversity: Ebert Speaker Tells History of Racial Divide in Medicine Minority Health Policy: Talks in Minority Health Policy Aim at Broad Health Equality New Books: The Spring Bookshelf Water Pore Structure Reveals Junction Function A Fast Track to Patient Confidence China Steps Forward Against AIDS   Yellen Named Head of PhD Program in Neuroscience HMS Makes Minor Revisions in Conflict of Interest Policy Dana-Farber President Elected to Academy of Arts and Sciences Weintraub Named Chief of Surgery at Cambridge Health Alliance Teaching Honored for 2004 HSDM Students Present Work at Poster Day HMS Student to Fence for U.S. in Athens NEPRC Opens New Research Building SPORE Grant Awarded in Kidney Cancer Research Stem Cell Head to Speak at Albright Symposium Rare Images of HMS Now Available on the Web Honors and Advances   Meeting Patient Expectations   In Health Care, Do We Get What We Pay For?   Front Page

INCIDENT REPORT Meeting Patient Expectations The response to this incident was written by Thomas Lee, HMS associate professor of medicine at Brigham and Women's Hospital. Incident: A surgeon routinely tells patients pre-operatively that they should not expect to see him postoperatively unless a serious complication occurs. Response: Some would say that the surgeon is being considerate by taking the time to shape the patients' expectations. After all, many physicians do not routinely see their patients after procedures--and do not warn their patients that this is their practice. For several reasons, though, I do not think that this is a great approach. First, patients want to talk to their surgeons after procedures. They have questions, they have fears, and they want to thank the surgeon when things go well. I think patients have a right to follow-up and a chance to ask questions at any time, but especially after we have conducted an invasive procedure. (As an internist, my policy is always to give patients follow-up communication after I have performed blood or other tests. I do not think it is adequate to say to patients, "I will contact you if any of the results are abnormal." They do not know when they can relax or if you have really looked at the test result.) Second, this approach may increase physicians' risk of malpractice. Some data indicating that physicians who work harder at communicating with patients are less likely to be sued (see The Journal of the American Medical Association 1997;277:553-559). Other data indicate that suits are more likely to reflect an angry patient than actual mistakes. Common sense dictates that physicians who see their patients after procedures, complicated or otherwise, are probably less likely to be sued. Finally, what is the patient going to think if this surgeon does show up? The patient will know that he or she is having a "serious complication." Not exactly a good way to put a patient in a positive frame of mind.