MacRMI Facebook MACRMI Twitter MacRMI LinkedIn

As a long-time admirer of MACRMI, I’m pleased to be asked to write a monthly blog examining the wealth of issues that surround medical error transparency.  My brother, Larry Kraman, and I have recently completed a documentary covering all aspects of the movement toward disclosure and resolution after bad things happen during medical care.  Several different stories are told in this film and one of the most prominent is the story of MACRMI and CARe. 


CARe (Communication, Apology, and Resolution) is a specific implementation of a patient-centered risk management process that has begun to gain traction around the country, and a few other countries, during the past 2 decades. Though they incorporate somewhat different details and are known by different names, the one thing that they have in common is a philosophy that is roughly the reverse of the traditional deny-and-defend approach in response to medical errors.  What makes the approach of MACRMI stand out from most of the rest are three fundamental elements: 1) the concentrated effort put into planning, preparation and design of a system requiring the cooperation of participants who usually play pugnacious roles in such matters; 2) the involvement of several hospitals with the potential of adding more; and 3) the fact that fair compensation is a stated, key part of the system, thereby truly putting the wellbeing of the patient first.


When contemplating systems such as CARe, although virtually everyone agrees on the ethics, some see the process as impossibly difficult to implement, others as potentially unaffordable and yet others as a simple matter, if only people would just do it.  It isn’t any of those things. Changing a culture that has been in place within American medicine for over 150 years and in which large amounts of money are at stake is invariably difficult regardless of how morally right the change is.  Nevertheless, it is being done and the eventual agreement among the participants and positive outcomes as told in the recorded interviews are compelling.  The results of these changes are, and will continue to be, transformative.


Our film, Full Disclosure: The Search for Medical Error Transparency was self-funded in its making so no third party affected the editorial content. Using interviews with dozens of key players, my brother, the film maker (with a bit of help from me) has tried to illuminate the problems, disagreements and several key successes achieved by the doctors, lawyers and patients involved in this culture change. The film is undergoing final polishing and will be complete within a few months. Our intent is for it to be easily and economically available to any organization wishing to use it for education or training.


Many of the interviews filmed for our documentary, about 50 hours total, did not make it into the final 90-minute film but are nevertheless interesting, instructive and often riveting.  In this series of blogs, I will focus on these stories and offer links to the actual edited interviews.  These stories are too good to languish on the cutting room floor.


A link to a 7-minute trailer of our documentary is provided here.


For more information about the film, contact Larry at


Next month’s blog:  How anesthesiologists achieved drastic improvements in patient safety without outside help.



Steve Kraman, M.D.

Lexington, Kentucky

Loading Conversation