Disclosure & Apology
"Disclosure is defined as a transparent process in which the known facts of a case are discussed with a patient, family members or both."
We have a professional ethical obligation to inform patients regarding their care. This is especially important when there has been an error. However, several research studies have shown that clinicians are not skilled in having discussions with patients and families after medical errors. It seems reasonable to assume that some of the barriers to meeting patient needs after errors might include the clinicians sense of vulnerability and emotional distress.
Grappling with a medical error that causes harm to a patient is one of the most challenging moments of any clinician's career. Many studies have documented the negative emotional impact on clinicians who have made errors. In addition to the sadness at seeing a patient experience suffering, there are professional, personal and societal expectations of perfection that, although we may know intellectually are unrealistic, we feel deeply on an emotional level. Making an error shatters any illusions of perfection and can result in clinicians feeling ashamed, income….
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Because this process can be emotionally challenging for physicians, it is important for health care institutions to provide both disclosure coaching as well as clinician peer support. Disclosure coaching is needed because few clinicians have vast experience in disclosing errors and sometimes the circumstances of the adverse event are complicated enough that it is difficult to know what to say and how to say it.
It is important for all clinicians to understand some basic principles underlying effective disclosure conversations:
Express empathy. One of the most direct ways to do so is to say " I am sorry this happened. It is not what you or we expected."
The most important principle is to do what is best for the patient and family. The question is not "What would I want my physician to do or say in this instance?" Rather it is trying to understand the needs of the patient and family in the moment and as they evolve.
Always share with the patient the known facts as soon as possible. It is inadvisable to wait until there has been a root cause analysis or any process that will flesh out all the details.
If there has clearly been an error, then apologize. For example, you might say "I am sorry we have you the wrong dose of medication."
Be aware of your emotions so that they do not interfere with your ability to be transparent and compassionate.