Frankly disclosing error can be challenging for practitioners.54,55
Medical professionals have high expectations of themselves and, not surprisingly, find it difficult to acknowledge their errors openly before patients and colleagues.56
Disclosing such events may be less traumatic if practitioners follow practical guidelines for breaking bad news.57
If uncertain about how to talk to a patient concerning an error, physicians would be wise to seek advice from the CMPA or skilled hospital representatives before doing so.
When harm to a patient occurs because of error, it is imperative to be sure about what happened. As for disclosing harm or the risk of harm in general,58
the need to disclose an error to a patient is a proportionate one: it increases as the harm or risk of harm to the patient increases. The more challenging situation arises when an error is made but there is no current harm. Barring evidence to the contrary, it should be assumed that the patient would want full disclosure, particularly when harm may occur or when its potential occurrence requires departure from the usual care plan. Disclosure should, of course, take place at the right time, when the patient is medically stable enough to absorb the information, and in the right setting.
Physicians should take the lead in disclosing error to patients and their families.59
They should try not to act defensively or evasively but, rather, to explain what happened in an objective and narrative way, trying to avoid reacting to the charged response that such disclosure can generate. A physician may say “I'm sorry.” Patients often appreciate this form of acknowledgment and empathy. This may help to strengthen, rather than undermine, the physician–patient relationship.
If the adverse outcome requires medical attention, practitioners should disclose this and seek prompt help. Patients may be reassured by knowing that the physician is not only remorseful but also dedicated to rectifying the harm, and preventing further harm, by a clearly defined course of action. It may be wise to offer to get a second opinion or the option of transferring care to another physician if the physician–patient relationship no longer seems viable.
Meeting with patients, and their families if necessary, in a timely way after an error, especially if serious, can help avoid suspicions about a “cover-up.” Although worrisome to clinicians, having lawyers present, if desired by the patient or the family, may help to ensure that all their concerns are expressed and addressed. A team meeting in advance of a conference with the patient and family should establish that all relevant information regarding the sequence of events leading to the adverse outcome is at hand, mutually understood and presented as clearly and openly as possible. It will also be important to say what, if anything, will be done to prevent the occurrence of such errors in the future. Patients and families may accept what has happened to them if they can be reassured that medical care will be improved in the future.
When practitioners witness errors made by other health care providers, they have an ethical, if not legal, obligation to act on that information. Depending on the circumstances and the magnitude of the error, options range from encouraging disclosure by the erring practitioner to discussing the situation with the hospital unit director, the department chief, risk management, a CMPA representative or a representative from a provincial professional association. Errors causing serious medical harm are ignored to the peril of the profession as well as the public.60,61