Salim El-Hoss Bioethics and Professionalism Program at the American University of Beirut Faculty of Medicine and Medical Center Discussed “Medical Malpractice, Errors and Disclosure”

(Tuesday February 17, 2015) Beirut, Lebanon – The Salim El-Hoss Bioethics and Professionalism Program at the American University of Beirut, Faculty of Medicine and Medical Center in joint providership with Cleveland Clinic held its 7^th regional conference entitled “Medical Malpractice, Errors and Disclosure” on Saturday, January 31, 2015 at the Golden Tulip Hotel in Beirut. The conference included a series of presentations by Dr. Thalia Arawi, Founding Director of the Salim El-Hoss Bioethics & Professionalism Program and Clinical Bioethicist at the American University of Beirut Faculty of Medicine and Medical Center, Dr. Haavi Morreim, Professor, Department of Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Maitre Charles Ghafari, lawyer of the Lebanese Order of Physicians, Dr. Fadi El-Jardali, Associate Professor, Department of Health Management and Policy, Faculty of Health Sciences, AUB, Dr. Salah Zeineldine, Assistant Professor, Department of Internal Medicine, Dr. Adnan Tahir, Medical Center Director and Chief Medical Officer, and Dr. Mondher Letaief, Technical Officer, Department of Health System Development, WHO-EMRO. It was attended by Dr. Kamal Badr, Associate Dean for Medical Education representing Mohamed Sayegh, Vice President of Medical Affairs and Raja N. Khuri Dean of the Faculty of Medicine at AUB, doctors, allied health professionals, nurses, students, lawyers, policy makers, members of the healthcare team and risk managers from Lebanon and the Arab region. “Medical mistakes are considered to be the third leading cause of death in the United States,” said Dr. Badr. “Lebanon witnessed in the past few years several cases related to medical mistakes by doctors or hospitals. Medical malpractice lawsuits are increasing and the patient/physician relationship, in some cases, lacks transparency and ownership. In line with AUBMC 2020 Vision, SHBPP is committed to enhancing healthcare offerings by raising awareness through such conferences in Lebanon and the region,” he added.  Dr. Badr highlighted in his presentation the significance of the workshop in discussing the magnitude of medical malpractice, its impact on patient safety, and ways to avoid it. Dr. Thalia Arawi followed with a presentation entitled “The Practice of Medicine Is an Art” in which she emphasized the role played by the physician to make use of moral wisdom and phronesis when adverse patient outcomes arise and the importance of aligning the hidden and informal curricula with the formal one. She also suggested the establishment of a national forum for doctors to disclose and share medical expertise and noted the crucial role played by responsible media. In his presentation, Dr. Fadi El-Jardali addressed the need to create organizational and policy level support for improving patient safety noting that patient safety faces many challenges such as the difficulty in recognizing errors, the lack of an error identification system, and the different concerns about liability. Dr. El-Jardali discussed several case studies from Lebanon and other countries in the region that show how patient safety culture -among others- is a major determinant in medical malpractice. He stated that organizations ought to protect patient safety through applying a system error approach, seeking accreditation, giving incentives, and enhancing their value based purchasing. Keynote speaker, Dr. Morreim, explained that after harm occurs, the patient, his family and members of the healthcare team all have the same needs which include understanding what has happened, seeking quality improvement to avoid future errors, reconciliation and fair compensation. Further, Dr. Morreim explained two different approaches – the “system based analysis approach” and the “communication and resolution approach” –  to minimize errors, provide quality care, and help physicians serve their patients best. Maitre Ghafari elaborated on the ethical and legal aspects of medical errors in Lebanon. He gave an overview of the Lebanese Code of Medical Ethics and the current rectifications made to it. He described the role of the Lebanese Order of Physicians (LOP) in following up on malpractice cases. Dr. Salah Zeineldine gave a lecture on the responsibility and liability of trainees in medical errors. He mentioned examples of medical trainees’ errors and their legal and ethical repercussions on the hospital and involved medical team. Dr. Zeineldine highlighted the idea that in order to responsibly care for patients and minimize harm, some measures should be taken.  These should include reducing sleep deprivation and duty hours, recognizing the impaired physician, and disclosing errors. Dr. Adnan Tahir gave a lecture on developing safety metrics and improving error reporting. He identified methods to effectively target, review, and reduce errors and explained how the workflow process within a hospital could be improved using an error reduction model. Dr. Letaief shared with the audience some statistics and facts on adverse events and medical malpractice from the EMRO. He then described some of the regulatory mechanisms - such as open disclosure, public reporting, quality assurance and litigation - used in addressing medical malpractice. He stressed the importance of finding equilibrium to ensure patient safety while protecting the medical profession. Dr. Letaif said that patient safety and quality of care are highly variable across the region, yet they all require systematic efforts and regulatory approaches to prevent medical malpractice. Dr. Morreim gave a concluding remark at the end of the conference stating: “in the US, all what it really took is one courageous institution to lead the way, and I see the makings of a very courageous institution (which) has already begun to lead the way.”