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Principles to Follow in Talking with Patients About Other Clinicians' Errors

November 17, 2016

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While much attention, literature, and training has been developed over the past decade on the subject of one’s own medical errors and the process of disclosure, very little has been explored regarding how to respond to patients and colleagues when one becomes aware of the errors of other clinicians. Supported by a grant from the Greenwall Foundation and by the Risk Management Foundation of the Harvard Medical Institutions, an international panel assembled to develop a collaborative approach to the issue. Subsequently, The New England Journal of Medicine published an article[1] entitled “Talking with Patients about Other Clinicians’ Errors.”  Some of the excerpted principles and observations of the study included:

 

“Clinicians might be tempted to use the patient’s medical record to raise concerns about a potential error without initiating a direct conversation.” In our experience, this approach is counterproductive to the aims of improving the patient’s medical care, informing, and potentially educating the previously erring clinician, and provides evidence that could be taken out of context in a subsequent liability action.

“Patients and families should come first.” Disclosure is ethically required, and patients and families should not bear the burden of digging for information about their care. There is a professional ethical responsibility to treat the patient, and to not put the needs of themselves, or the anxieties of an uncomfortable discussion with the other clinician, above that.

“Explore, do not ignore.” While an ethical duty to disclose exists, that disclosure process must also contain the appropriate factual information in an appropriate setting over an appropriate course of time. The NEJM article contains a useful table outlining various clinical situations, the participants in the disclosure, and the rationale for disclosing harmful errors in common situations involving other clinicians. Communication with all the previous clinicians, and an attempt to resolve the factual history and the correct subsequent course should precede the disclosure process with the patient and family.  However, the patient’s time frame and “need to know” dictates that the communication among clinicians is as time sensitive as is practically possible. These situations do not get better with a delay of disclosure.

“Institutions should lead.” Colleague-to-colleague discussions and an investigation into the facts and a resolution of the proper subsequent course requires an institution that is supportive and ultimately expects accountability and professionalism of its members. Just-in-time disclosure coaching programs can assist with these difficult situations. Involvement of trusted leaders and physician champions can greatly assist. Strive to develop a “just culture,” which the article describes as “atmospheres of trust in which people are encouraged, even rewarded, for providing essential safety-related information—but in which they are also clear about where the line must be drawn between acceptable and unacceptable behavior.”

Call MagMutual Early

We recognize the incredible complexity and sensitivity that these situations often pose. There is no single correct approach in every situation. Please call us at 800-282-4882 and a member of our Patient Safety Team may assist in discussing the approach to these difficult situations.

[1] N Engl J Med 369;18 1752-1757– October 31, 2013

Created by MagMutual from materials provided by COPIC as part of MagMutual and COPIC’s alliance to improve patient safety and quality of care for all of our PolicyOwners. 

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.

Footnotes