The first thing to do after a medical error, with Anthony Orsini, D.O.

A dosing mistake happens. The patient is fine, the process caught most of it and nobody outside the practice knows. Anthony Orsini, D.O., says the decision most practices make next, which is to say nothing, is what turns a minor error into a lost patient and sometimes a claim.

Medical Economics Managing Editor Todd Shryock sat down with Orsini, a neonatologist, founder of The Orsini Way and a member of the Medical Economics editorial advisory board.

Orsini has been training physicians and staff on difficult conversations since 2010, and much of what he covers here is operational: who a physician should call first when an error surfaces, why the staff member involved belongs in a pre-disclosure meeting, why the physician rather than risk management or legal counsel should lead the conversation with the family, and what a practice can do when there is no risk management department down the hall. He also explains why every error gets disclosed regardless of how minor it looks, using a case where a hospital decided a small dosing mistake was not worth mentioning and the mother found out anyway.

Orsini's new Medical Economics series, Conversations that Matter, debuted Sept. 2. The first episode looks at why breaking bad news goes wrong so often.

Don't miss our recent episodes on physician corporatization, malpractice rates, physician-owned hospitals and vaccine stocking costs.

Music Credits:

Ambient Jazz by AurbanniAudio - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:26 | Cold open Orsini on why the most empathetic words fail when a physician's posture contradicts them.

0:26 – 2:00 | Introduction Austin Littrell introduces the episode, the guest and the debut of Orsini's new series.

2:00 – 2:35 | Meet Anthony Orsini Todd Shryock introduces Orsini and The Orsini Way.

2:35 – 7:27 | The most common disclosure mistakes Failing to disclose at all, getting defensive rather than transparent, retreating into medical jargon and ignoring nonverbal communication. Orsini cites a study finding fewer than half of physicians know the steps to take after an error.

7:27 – 9:59 | Why speculating is the worst move The brain reads nonverbal cues before words, an angry family is a normal response, and naming a cause before the review is finished routinely turns out to be wrong.

9:59 – 13:33 | What families actually want to hear Orsini says 39 states now have full or partial apology laws, and that in role-play training physicians more often over-claim fault than dodge it. A morphine dosing example shows why errors are almost always a process breakdown.

13:33 – 15:28 | The data behind transparency Orsini walks through the University of Michigan findings on claims, liability costs and time to resolution.

15:28 – 18:02 | Training body language Videotaped role play, the long sitter posture, and why a relaxed stance that builds rapport in a routine visit destroys credibility in a disclosure.

18:02 – 18:55 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

18:55 – 21:56 | Every error gets disclosed Orsini tells the story of a minor morphine overdose a hospital chose not to report, and what happened when the mother found out anyway.

21:56 – 24:22 | Who should deliver the news Why the physician should lead the disclosure rather than risk management or legal counsel, and how the pre-disclosure meeting should work.

24:22 – 27:11 | Be prepared before it happens Why physicians avoid training for medical errors, what resources exist for practices outside a hospital system, and Orsini's closing message.

27:11 – End | Closing thoughts and outro Shryock thanks Orsini, and Littrell wraps the episode.