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This article is sponsored by MagMutual.

We have a special sponsored episode from MagMutual. We welcome William Kanich. He’s an emergency physician and currently the executive chairperson of MagMutual Insurance Company. We explore how physicians can navigate unexpected medical outcomes while preserving trust with their patients. Through Dr. Kanich’s clinical and leadership experience, the conversation examines common challenges, practical approaches, and the role of structured support programs like the Preserve Program. The discussion also looks ahead to how the healthcare industry can continue evolving to better support physicians in maintaining strong patient relationships.

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Transcript

Kevin Pho: Hi. Welcome to the show where we share the stories of the many who intersect with our health care system but are rarely heard from. Subscribe at KevinMD.com/podcast. Today we have a special sponsored episode from MagMutual. We welcome William Kanich. He is an emergency physician and currently the executive chairperson of MagMutual Insurance Company.

We explore how physicians can navigate unexpected medical outcomes while preserving trust with their patients. Through Dr. Kanich’s clinical and leadership experience, the conversation examines common challenges, practical approaches, and the role of structured support programs like the Preserve program. The discussion also looks ahead to how the health care industry can continue evolving to better support physicians in maintaining strong patient relationships. Find out more at MagMutual.com. The link will be in the show notes. Bill, welcome to the show.

William Kanich: Kevin, thank you so much. It is a pleasure to be here on your esteemed program. Thank you.

Kevin Pho: All right. Let’s start by briefly sharing your story and journey.

William Kanich: Sure. I would be happy to. I am going to warn you right off the bat, Kevin: I went to law school before I went to medical school, so I can talk a long time. In the interest of your audience, please feel free to cut me off at any time.

I graduated from college and I did go to law school. I am a member of the bar in North Carolina, but decided that wasn’t my calling and ended up going to medical school in Virginia. I did my residency in emergency medicine at the University of Virginia and practiced emergency medicine in South Carolina for about 15 years.

While I was there, I started working for MagMutual, which is an insurer of physicians and hospitals. I started consulting with their claims department on claims that were made against their insured physicians and hospitals. I enjoyed the company so much and thought the mission was so wonderful that I ended up joining full-time about eight years ago. I was the chief medical officer here for about four years. About four years ago, the board of directors asked me to become the executive chair of the board. So I have been doing that for about four years now. It is different from clinical practice. Instead of seeing a few patients a day, I feel like I now take care of tens of thousands of doctors a day. So it has been a wonderful journey for me.

Kevin Pho: All right, wonderful. So let’s jump into the first section of our show today: challenges in supporting the patient-physician relationship. Bill, what are some of the biggest challenges physicians face when trying to maintain trust with patients after an unexpected medical outcome?

William Kanich: Kevin, I think we are fortunate in that we are in a profession where trust is kind of built-in. I think in general, while the numbers may go up and down, people trust physicians. We enjoy that. I think one of the hardest challenges, one of the biggest challenges, is expectations.

We don’t, as physicians generally, give guarantees about outcomes, but I think nonetheless there is this sort of tacit understanding that patients have that things are going to turn out, and they don’t always turn out the best way. To a certain extent, one of the biggest challenges is addressing those expectations. We always want to meet our patients’ expectations because they are generally aligned with our own, but sometimes they don’t. One of those times is when you have an unexpected outcome. I think in general, we have to talk to patients about: “Hey, I know your expectations were here. And I know this happened. Let me bridge those two things and try to keep that trust between us. Let me explain why I think something happened that wasn’t what you or I expected to happen.”

Kevin Pho: Why do you think some physicians hesitate to disclose adverse outcomes or express concern even when they want to?

William Kanich: I think there is a lot of fear around that. There is the fear of the legal ramifications: “What if I say something that is wrong or that implicates me of doing something bad?” I think there is a reputational worry: “Hey, if I admit I have done something wrong and this gets out, does that mean my colleagues won’t refer patients to me anymore? Does that mean this patient won’t come back to me anymore?”

Also, Kevin, as you know, medical care is becoming so much more consolidated. The last number I saw was that 80 percent of physicians are now employed by hospitals or private firms of some sort. If I start admitting something didn’t go exactly the way that one is, is my employer going to think that I am not a very good physician? Could I lose my job? Could somebody complain to a medical board? So I think there is a lot of fear out there. And listen, some of it is founded (we can talk about that), but I think there is a lot of fear around this whole idea of disclosing that something has gone wrong and let’s talk about it.

Kevin Pho: So you specifically mentioned the fear of litigation and the fear of reputational damage. How does that fear affect the way physicians handle these situations?

William Kanich: For generations past, our parents’ generations, I think the way those fears affect them is just to clam up: “Hey, let’s put up the wall. Something is going wrong. I am just going not to … maybe it will go away. Let’s just not discuss it.” I think those fears fit into that. I think that is changing slowly. It is difficult, but I think those fears regarding the reputational, economic, and legal possible ramifications really have caused physicians in years past to shut down when it comes to talking about unexpected outcomes.

Kevin Pho: And in your experience, what misconceptions do patients often have about medical errors or unexpected outcomes?

William Kanich: I think the biggest misconception, and good Lord, we feed patients this all the time whether it is through popular culture or us talking to them, is that they see medical shows where miracles happen every week in a 60-minute episode, and they expect, again going back to expectations, that things always turn out right.

As physicians, we know that is not always the case. If you are the best gastroenterologist in the world, you can do a thousand colonoscopies just right. You are still going to have complications. I don’t know exactly what the rate is, 1 percent or 2 percent, but things go wrong. I think a misconception amongst patients is that things always go right when you and I know they don’t always go as expected.

Kevin Pho: The next section we are going to talk about is solutions and programmatic support. So Bill, how can structured programs or approaches help physicians navigate these difficult moments more confidently?

William Kanich: I think the number one way is what you said: structure. I think it is just giving physicians this rubric they can use to go through and say: “Hey, this is what this looks like. It starts here. Do this, do this, do this.” We are so comfortable when that middle-aged male with chest pain walks into the emergency department or our office or the cath lab. We are so comfortable with the approach. Every one of those patients is different, right? But we know the approach to that.

I think a structured approach to talking about unexpected outcomes does the same thing. It gives us that confidence: “Hey, I know how to approach this. Every case is different, yes, but I know how to approach each case with confidence.”

Kevin Pho: MagMutual’s Preserve program offers support for both communication and financial reimbursement. How do these components work together to help preserve the patient relationship?

William Kanich: Really good question, and I think really important. Both those things by themselves are important. When something goes not as expected, the communication part is important, and financially it could be important. Sometimes that unexpected outcome requires further surgery, further care, or further therapy. Each of those by themselves is good, but working together, that is so much more powerful.

Think back a couple of decades ago; there was this big push about “Sorry Works.” I think that is a really powerful program, and I still believe in saying “I am sorry” and showing empathy. But at the end of the day, going back to my colonoscopy example, the patient might say: “Hey doc, I appreciate you explaining this and saying sorry, but I still have to pay this surgeon over here to fix my colon. How do you help with that?”

I think the financial part comes in because it kind of closes that loop. The communication part explains what happened and what we are going to do to help fix your problem. The financial part comes in and says: “Hey, you are not going to be out of pocket. You are not going to be down because this unexpected outcome happened. We are going to take care of both those things.” So they really work together to make a more powerful approach to addressing unexpected outcomes. That is the nub of the Preserve program: it is those dual prongs, the communication part and the financial part when needed.

Kevin Pho: Can you give us some examples of what kind of impact you have seen from the program, either in terms of the patient response or physician experience?

William Kanich: Both. I think first and foremost regarding patient response: In America today, so many people live paycheck to paycheck. Our patients are no different. Not every patient, but a lot of patients are living paycheck to paycheck. All of a sudden, they have got this additional bill that they weren’t expecting. They didn’t budget for that. Maybe insurance doesn’t cover it. So many patients have come to us after the Preserve program saying: “Hey, really appreciate the communication, but also really appreciate that I wasn’t out of pocket any money for this to take care of this.”

For physicians too: Going back to the structured approach to talking about unexpected outcomes, many physicians, myself included, came through medical school and residency without a good idea of how to talk about when things just don’t go exactly as planned. We get physicians coming back to us all the time saying: “Thank you so much for educating me. Now the next time this happens, I will know how to approach this situation.” Because this was never addressed in my education, but it should have been. We are all going to experience unexpected outcomes no matter how good a physician you are. We need that in our tool belt to say: “How do I address this with the patient?”

Kevin Pho: We’re going to talk about more specifics of that approach and advice for physicians later on in the program. But before we do that, are there any other resources or tools that you think would strengthen the physician-patient relationship after an adverse event?

William Kanich: I think communication is important. I think the other thing is just giving resources. We can talk about this when we discuss how we approach this, but I think it is so important. A good analogy is informed consent. Informed consent isn’t sort of a one-and-done kind of thing. People may have questions the next day. This is the same thing. It is not a one-time event.

Inevitably, when you are talking to a patient, whether it is about an unexpected outcome or about your plan to deal with their chest pain, I figure they are hearing about 50 percent of what you are saying. Maybe they are comprehending, if we are lucky, 30 percent. You need to give patients that opportunity to come back to you and say: “Hey, I appreciate the time you spent. I have got a couple of follow-up questions.” Make sure we don’t just shut off patients and say this is a one-time event. We need to build that into our practice. I know we are all busy and we have got so many patients, but we need to build that into our practice to allow patients to come back with those follow-up questions.

Kevin Pho: You are listening to a special sponsored episode from MagMutual. We are talking to Dr. William Kanich, emergency physician and executive chairperson at MagMutual. We are exploring how physicians can navigate unexpected medical outcomes while preserving trust with their patients. Find out more at MagMutual.com. That’s MagMutual.com. The link will be in the show notes.

William, we’re going to talk about practical advice you can share with physicians. What advice would you give to a physician who’s unsure how to approach a conversation after an unexpected outcome?

William Kanich: Practical advice is where the rubber meets the road. It is important I learned about the Krebs cycle

[Image of the Krebs cycle]
, but it was more important that I learned how to deal with diabetic patients in the emergency department. Communication is the same way. It is easy to say, “Let’s communicate all this stuff,” but what does that really look like?

First and foremost, I would say preparation in advance. If you are going to have a conversation that you know could be difficult, difficult for you to explain what went on or difficult for the patient to hear, prepare. Review the patient’s case. You have probably had patients like this before. You may have had a complication like this before. What were the questions you have dealt with before? Anticipating those questions and how you will answer them is huge.

I think being honest and transparent is key. Part of that is honestly saying, “I don’t know.” You may be asked some questions where you don’t know the answer. It is fine to say, “I don’t know.” At the end of the day, that is a much better answer than trying to speculate. Speculating doesn’t help the patient and it doesn’t help you. I think just staying honest is important.

I think showing empathy is crucial. Again, the expectation wasn’t met, your expectation or the patient’s. Let the patient know that you understand that this isn’t the easiest day for them.

Kevin, I think taking responsibility is important. If you start pointing fingers, that doesn’t really help anybody. When it is appropriate, we need to be able to say: “That is on me. This was my job. This part of it didn’t turn out the way I expected. That is my responsibility.”

I think while you are having these conversations, one thing you can do is what is commonly called active listening, which I think just means listening sincerely. Listen to what your patient is telling you. Listen to what they are asking you. And if you can avoid those issues, please do. I strongly advise avoiding medical jargon and acronyms. That is the way you and I are used to talking to each other and our colleagues. It is not the way our patients will understand what they are going through.

Discuss next steps. Going back to that colonoscopy example: “Okay, you have got a perforated colon. Here is your condition. Here is what I suggest are our next steps. I have talked to these colleagues. Let me map out to you what I think the next hours, days, and weeks look like for you in your medical care.”

I think offering support and follow-up is really important. When I spoke to patients in the emergency department and they had an ongoing issue, I always tried to give them a phone number, somebody to call. “Here is your pressure relief valve. If you don’t know where to go next, I need you to call this number and somebody is going to answer and help you navigate through this.”

All that higher-level advice goes to approaching this with honesty, empathy, and a commitment to doing what is best for your patient. I think that is what we all want to do. But I think when it comes to these communications, keep those at the forefront. You are going to be fine in these communications.

Kevin Pho: I think one thing that struck me is those words, “I don’t know.” As physicians, we are just not often trained in showing that vulnerability and showing that transparency with patients. So I think what you said was tremendously powerful. Now, how can physicians balance the need for honesty with the risk of saying something that might later be misinterpreted legally?

William Kanich: Sure. No, I get that. Part of it is not speculating. I always worry about that somewhere down the road: “Well doc, you know, you said if you had done this, things would have turned out well.” The fact is we don’t know about that. You want to balance those things out. You want to be honest and you want to be transparent. You don’t want to say things that you can’t back up. I always tend toward a little bit of wanting to tip the scales in favor of overcommunicating.

As far as what is going to be interpreted down the road legally, I think when you have these discussions with patients, you want to document what the discussion was. In that documentation, you want to put: “Hey, here were the questions. Here is what I explained.” If something were to come up down the road, your insurance company like MagMutual or a lawyer who is representing you can refer back to that and say: “Oh Doc, I really appreciate your documenting this. I understand the spirit you went into this. I understand things may have been misinterpreted.” So if you are worried about that, make sure you document—well, not every word that is said, but the spirit in which you had that discussion.

Kevin Pho: You earlier mentioned peer support, and I think that is tremendously important because I’ve had guests on this podcast talk about how isolating it is for physicians who may be going through an adverse event and they’re often advised not to talk about the case with anybody else. Tell us more about the role of peer support or mentorship programs and how that helps physicians build confidence in these conversations.

William Kanich: I think there was a time in medicine where we all had to be brick walls. We were not going to show emotion, we were going to be strong. The fact of the matter is we are all human beings, and as physicians, a lot of our self-image and our self-worth is wrapped up in our profession. When something doesn’t turn out the way we want, some self-doubt can creep in there. It affects us all differently. We certainly see that when people are going through litigation. Litigation affects everybody because there is that self-doubt.

I think it is important that you have that peer support group. You have the mentor who has been doing what you have been doing for a long time, those peers that are on your level. And don’t underestimate the importance of family and friends. I think sometimes we are worried about employers or worrying about our reputation; we worry about our spouses and our kids: “Are they going to think we are different physicians that are not as good?” But I think if you try to keep that stuff all inside, Kevin, it just festers in there and nothing good happens.

So peer relationships, mentor relationships, and family relationships. Those are something you want to be cultivating every day. When you do have the unexpected outcome in that conversation with a patient, that is not the day you want to go out and look for a mentor. Hopefully, you have a mentor in place long before that.

One of the nice things about medical school and residency (and listen, everybody has got some criticism of it, and sure we could always do things better) is that the way it is set up, you are learning in sort of a hierarchical construct, which lends itself to developing those mentorship relationships. I would encourage younger folks watching this: Take advantage of that construct and reach out to the folks that you respect as physicians and make them your peers and mentors when you need them for something like this.

Kevin Pho: We are going to move now into the last section of our conversation today: looking ahead. We are going to talk about industry and cultural shifts. So William, how do you see the health care industry evolving in terms of supporting physicians through emotionally complex patient interactions?

William Kanich: We touched on earlier, Kevin, just the consolidation in health care and how physicians are more in employed situations as opposed to partnership groups. Groups are getting much larger now. That is a discussion for another day. Neither you nor I chose that; that is just market forces. But there are a lot of silver linings to that. One of them is resources.

As physicians get in groups that are much larger, their risk management resources, their peer support resources, and patient resources are much richer and more vibrant. We are seeing that in these bigger groups. I think these larger organizations understand the importance of—I am going to use a word we don’t like hearing as physicians, but “customer satisfaction.” At the end of the day, they are our patients, they are also our customers, and we want them to be satisfied. Part of that is to start this process of more open, honest communication. I think people from the business world and the financial world understand the importance of that more. So I think that is a cultural shift we will see as we congregate into these larger and larger groups with more and more resources.

Kevin Pho: You talk about cultural shifts. What are examples of these cultural shifts within medicine or society do you think are needed to normalize open communication after adverse events?

William Kanich: One of them is the fallibility of physicians. None of us are perfect. We all want our doctor to be perfect, just like I want my Delta airline pilot to be perfect too. But we all make mistakes. I think there is this cultural shift now that we realize that doctors, while for the vast, vast most part are so well-intentioned and so well-educated and so dedicated to doing what they want to do, yet things still sometimes aren’t going to turn out the way that we plan. I think that is a shift that is happening.

You could ask me for data to demonstrate that, and I don’t have it, Kevin, but we also ensure tens of thousands of physicians, and when I go out there and talk to them, I definitely get that feel now. And listen, part of that is out of necessity. Medical information is so much more accessible to patients now through the internet. There is some good information out there, there is some bad information. But again, I see physicians as the ultimate navigator of all that information.

So we have got to communicate better. We have got to have this cultural shift that says physicians can make errors. It happens. Things don’t turn out the way planned. And when that does happen, there is going to be this much more open willingness to discuss that: what happened, why it happened, why I am not going to let it happen again, and what is going to happen for you next, Mr. Patient.

Kevin Pho: If you could change one thing about how physicians are trained or supported in this area, what would it be?

William Kanich: It would be an earlier addressing of this issue in medical school and residency. I get it: medical school and residency is so thick, there is so much medicine to learn, and we want to learn to become good doctors. But this is part of it. In my residency, I didn’t really get much education, if at all, on errors and how we deal with unexpected outcomes. I didn’t get much education on medical malpractice insurance. I didn’t get much education on how you run a practice. All those things are important. So I know we do ask residency to do so much. But if there is one thing I could change, it would be a carve-out in that time because I think this is that important to address it within residency.

Kevin Pho: Do you think patients today expect different levels of transparency and communication than they did 10 or 20 years ago?

William Kanich: I think so, and I think that also goes back to just information being much more readily accessible to patients. 20, 30 years ago, the surgeon has got somebody in their office talking about fundoplication . The patient has got nowhere to go when they are at home to figure out what exactly that is. Now there is so much information out there, and I think, yeah, that has raised the expectation. “Hey Doc, I appreciate you letting me know I need this. I went home, I read this, I read that there are these possible complications. Can we talk about that?” So yeah, I think that has raised expectations for how much communication and transparency are needed today.

Kevin Pho: And looking ahead, what would best practice communication after unexpected outcomes ideally look like in the next decade?

William Kanich: I think if there is one shift that I could implement right away, Kevin, it would be that we as a profession become less reactionary and more proactive when it comes to addressing this. Sometimes doctors are like: “I don’t know if I should address this. Hopefully it doesn’t come up. Maybe they won’t bring it up.” I think we need to be more proactive and say: “Look, this operation, I just did 96.7 percent of it was great, but let me just let you know there are a couple of things that happened that I want to make you aware of—not saying it is a problem, but let’s just talk about these little things that didn’t go exactly as planned.” I think we need to become just more proactive on that, and I think that will also enhance the trust that our patients and society has in us as physicians.

Kevin Pho: And my final question: Let’s end with some take-home messages that you want to leave with the KevinMD audience.

William Kanich: I appreciate that. My number one message is: Look, I really enjoy being a physician. I work full-time for an insurance company now. I will always identify as a physician because I am so proud of that. I am proud of what it took to become this, and I am proud of my dedication.

I think we need to remember that as long as we just keep our patients at the forefront of everything we do, as long as we draw on that wonderful education we got in medical school and residency, we are going to do the right things. Trust your gut. Do what is right for the patient. Don’t worry. Legally, if you need us, your insurance company will be there. Don’t worry about that. Focus on the patient. Things will work out okay.

Kevin Pho: You’ve listened to a special sponsored episode from MagMutual, exploring how physicians can navigate unexpected medical outcomes while preserving trust with their patients. Find out more at MagMutual.com. That’s MagMutual.com. The link will be in the show notes.

William, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

William Kanich: Kevin, thank you for your time. Thank you to your audience so much for their time.