Conversations with patients who have been harmed by the care they received serve more than one important purpose. Among other things, these conversations demonstrate respect for the individual harmed, provide an opportunity for patients to be heard, and reinforce trust between the patient and provider. Often, these conversations will include members of the patient’s family.
The best practice is to disclose the error if:
Minor errors that do not reach the patient generally are not disclosed.
Note that in Massachusetts, when a health care provider’s mistake results in an unanticipated outcome with significant medical complication, the provider must fully inform the patient and, when appropriate, the patient's family, about the unanticipated outcome.
It is. Patients should be told as soon as the error is recognized and the patient is ready physically and psychologically to hear the information. Ideally, this would be within 24 hours of the event. According to experts, early disclosure is an essential element of trust between a patient and his or her care providers.
Consider their level of involvement in the event, their emotional state, and their capacity to present themselves as an engaged member of the team. If they are not capable of making a positive contribution, their involvement should be deferred until later. Others who are not clinically involved (such as a risk manager) should usually not participate in the initial meeting.
Try to determine whether it would be helpful to have chaplains, friends, or other family members present. If English is not the patient's primary language, arrange for the services of an interpreter.
Experts agree that the conversation should include:
If an error was made, the provider should admit it and apologize for it. In the initial conversation, it’s best not to speculate about root causes of the event or assign blame to another member of the care team. To the degree possible, avoid medical jargon.
The best person to lead the conversation is almost always the physician most responsible for the patient’s care. There may be circumstances when it’s equally appropriate for someone else to lead the conversation, such as the member of the care team who committed the error or a medical professional the patient knows well and trusts. A physician who feels he or she cannot appropriately lead a conversation with a patient should consider asking a supportive colleague or other appropriate person from the organization to assist.
Outline a care plan for the patient's health needs going forward and offer other support services, such as chaplains, social workers, patient advocates, etc. Consider whether the patient's trust of the existing care team can be supported and maintained by involvement of additional sub-specialists or by requests for second opinions, and respect the patient's choice to have alternative care providers if necessary.
Yes. Medically Induced Trauma Supports Services (MITSS) — a nonprofit with extensive experience supporting patients and caregivers after a serious medical injury — has developed a model known as LEND.
Listening. The goal of listening in this situation is not to placate, but to demonstrate a desire to understand how the patient feels. Listening in this way is of enormous value to the patient/family member.
Empathetic Response. While it is impossible to completely understand what the patient is going through, it is important to show a desire to understand and a willingness to be supportive. The focus here is not on fixing the problem, but allowing the patient/family member a place to express their pain. If you know this is not the right position for you, send someone else.
Needs Assessment. Throughout the conversation, try to identify the person’s needs. Stress may be related to:
Reassuring a person of their value as a human being is vital after an adverse medical event.
Direct to Service. It is very important to follow through with commitments made and direct the patient or family member to any and all services that may benefit them.
Yes. The care team or facility administration should maintain an open line of communication with the patient. There should be an ongoing expression of support and concern, and — when appropriate — coordination of follow-up care related to the medical injury. In addition, any significant learning from the event investigation should be shared with the patient as promptly as possible.
Remember that rebuilding the relationship with the patient and family may take time. Disclosure is the right thing to do even if the patient does not immediately acknowledge your efforts to be honest, straightforward and compassionate with thanks or "forgiveness."
Yes. Medically Induced Trauma Supports Services (MITSS) is a national organization based in Massachusetts that offers a variety of resources and services for patients and families:
MITSS provides ongoing therapeutic educational support groups in Chestnut Hill, just outside of Boston. These groups are led by an experienced clinical psychologist. They assist patients and their families through the healing process in a supportive and caring environment.
This outlet connects patients who have been affected by medical error to help participants feel supported, understood, and safe. These sessions promote sharing of experiences, sharing of coping skills, a decreased sense of isolation, and an increased sense of empowerment.
MITSS operates a toll-free hotline (1-888-36MITSS or 1-888-366-4877). Staff and volunteers offer support, help callers find support services in their local areas, and provide advice on navigating the healthcare system.
Yes. As noted earlier, under Massachusetts law, when a health care provider’s mistake results in an unanticipated outcome with significant medical complication, the provider must fully inform the patient and, when appropriate, the patient's family, about the unanticipated outcome.
In addition, when an adverse event occurs at a hospital or ambulatory surgery center — and meets the state's criteria to be classified as a serious reportable event (SRE) — there are special rules about informing the patient during at least two stages of the reporting process: