Medical error can be thought of being due to (A) an isolated or series of clinician mistake, (B) a system failure, or (C) both.
Discussing an adverse outcome related to medical error is challenging under the best of circumstances - for both the clinician and the patient or family. Errors can damage a clinician’s self-esteem, confidence, and reputation, and lead to costly and unpleasant legal action. Timely disclosure of error is considered a standard of quality patient care.
Unanticipated outcomes of medical care also occur and can be perceived as errors by patients/families even if not the consequence of a “mistake”.
• Whoever committed the error (physician, nurse, or resident), the attending physician has final responsibility for the patient’s care and should lead the discussion – it should be limited to just those healthcare professionals directly involved.
• Discussion must take place as soon as possible after the error is identified – the appropriate people must be there. The meeting should be held in a place without distractors; enough time should be available.
• The pertinent facts of the case should be reviewed to be prepared to answer any detailed questions that the patient/family might have.
• Other consultants/ancillary staff should not discuss the error with the patient/family – multiple versions will likely confuse rather than clarify.
• The institution’s risk manager will be aware of the case should legal inquiries be made. Discussing errors with patients/families is a clinical task – part of clinicians’ obligation to openly share medical information – not a legal task.
• Discussion must be clear, concise, and honest, without medical jargon or lengthy explanations.
• The patient and family must have time for questions, emotional reactions, or silence.
• If the adverse outcome was a result of error (either individual or system-wide), it is basic to apologize for the error and its outcome.
• If the outcome was unanticipated but not clearly avoidable express, it is required to regret and sorrow.
• The PC team and the institution must commit to investigate and consider any individual or systemic deficiencies.
• The discussion must be documented; refer legal inquiries to the institution’s risk manager.
Discussing error requires professionalism and openness. It is an ethical requisite, a requisite skill and a key to maintaining a healthy clinician-patient relationship.
See reference for more information.
Adapted from Bradley C, Brasel K. Disclosing medical error. Palliative Care Network of Wisconsin. Fast facts and concepts #194. Internet. Accessed on January 5, 2019.