We strive to help every physician do the right thing in the right way. We provide guidelines that physicians can use in their office practices to enhance their effectiveness when disclosing adverse events and complications.
The Doctors Company supports the American Medical Association’s policy that following an unanticipated outcome, the physician is ethically required to inform the patient of all the facts necessary to ensure an understanding of what occurred. The ethical rationale is that the patient and his or her family have a right to know what happened. Simply put, it’s the right thing to do.
Patients have a right to be informed of the medical facts pertaining to their health status and medical treatment. Physicians have a responsibility to provide accurate, timely information to patients and, when appropriate, to the patient’s family members about events that affect the patient’s health status and future treatment needs—including the disclosure of adverse events and outcomes.
The Doctors Company encourages members to cooperate with institutional adverse event disclosure programs by disclosing adverse events and outcomes that result in patient injury.
Physicians are encouraged to seek guidance from individuals with patient safety and risk management expertise in both the communication and reporting of adverse events.
Physicians also have a responsibility to the patient, their colleagues, and their healthcare organization to avoid gratuitous blame and unsubstantiated speculation before a detailed review and analysis have disclosed the facts surrounding an adverse event or outcome.
Our experience has shown that adverse events tend to fall into three categories:
A. Medical and/or System Error
B. Known Risk/Complication or Unforeseeable Event
C. Unexplained Change in Patient Status or New Diagnosis of Late-Stage Disease
Based on the information you provide to the patient safety risk manager and the event classification assigned after all information is known, you will be guided through the steps for handling the disclosure to the patient and, when appropriate, the family. Your patient safety risk manager will also provide advice on working with the hospital/facility in which the event occurred or advice on how to proceed if the event occurred in your office.
If you would like information on specific state laws governing apology, please contact your patient safety risk manager.
Error is defined by the National Quality Forum Consensus report titled Standardizing a Patient Safety Taxonomy as “the failure to perform a task satisfactorily against customary standards and the failure cannot be attributed to causes beyond the patient or provider.” When the investigation (including a sentinel event root cause analysis) is complete and the cause is determined to be medical and/or system error, a disclosure meeting should take place with the patient or family.
The key factor in this category is preventability. Disclosure communications following unpreventable complications or unforeseeable events need to be forthright, open, and compassionate, though they differ qualitatively from apologies after preventable errors.
The main challenge in communicating after a Category C event is the avoidance of a premature conclusion that a severe and surprising outcome must be due to a negligent error. It is especially important in these circumstances to limit the information conveyed to the confirmed details and to provide ongoing updates as new information becomes available. These cases are particularly vulnerable to retraction and correction cycles that render all subsequent communications with the patient and family questionable.
We understand that a conversation with a patient or family following an adverse outcome can be difficult and that you may have questions about how to handle disclosure. Our patient safety risk managers can help you navigate the challenges by offering support, guidance, and resources—so you can do the right thing, in the right way.
We encourage members to contact The Doctors Company for assistance in disclosing an adverse event. Please call the Patient Safety Department at (800) 421-2368, extension 1243, and a patient safety risk manager will assist you.
Appendix 1—Medical Record Disclosure Report
Appendix 2—Empathetic and Non-Empathetic Statements
Appendix 3—Disclosure Scenarios
Appendix 4—Adverse Outcome Flowchart
Appendix 5—Disclosure Meeting Protocol
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.