Disclosure Resources

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.

Adverse Event Categories

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.

A. Medical and/or System Error 

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.

B. Known Risk/Complication or Unforeseeable Event 

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.

  1. Review the known facts surrounding the adverse outcome.
  2. Determine if the event was preventable.
  3. Review your process of informed consent to determine if the known risk or complication was discussed.
  4. Proceed to the disclosure meeting with the patient or family. Focus on discussing the cause(s) of the known risk or complication. Review the informed consent if appropriate.

C. Unexplained Change in Patient Status or New Diagnosis of
Late-Stage Disease 

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.

  1. Conduct an internal review of the medical records to determine exactly what happened and to determine if the status change was preventable or if the new diagnosis could have or should have been made earlier.
  2. If appropriate, initiate an external expert review. Peer reviews of the medical care with the outcome blinded can lend unique insight into these events.
  3. If a sentinel event occurred, a root cause analysis is appropriate.
  4. Proceed to the disclosure meeting. Review the findings of your medical record review and investigation. Explain the implications of the change in the patient’s health status and how this will affect his or her subsequent disease management. Discuss the prognosis and management of the newly diagnosed late-stage disease.

Contacting The Doctors Company 

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 and a patient safety risk manager will assist you.

Appendix 1—Empathetic and Non-Empathetic Statements
Appendix 2—Disclosure Scenarios
Appendix 3—Adverse Outcome Flowchart
Appendix 4—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 considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.