Tips for disclosing medical errors
NATIONAL HARBOR, Md. — Disclosing medical errors can be incredibly challenging conversations, but when done the right way by presenting fact-based information and being authentic and compassionate, both hospitalists and patients and their families benefit, Aaron C. Hamilton, MD, MBA, hospitalist at Cleveland Clinic, said during his presentation at Hospital Medicine 2019.
“These conversations are a variation on any difficult conversation that you navigate as a hospitalist,” he said.
In recent years, there has been a paradigm shift to more transparent communication with patients, according to Hamilton. Research has shown that error disclosure increases incident reports and decreases claims and costs, he said. Beyond the evidence that error disclosure is beneficial to patients and practice, it is a moral and ethical obligation, he said.
“The disclosure process is an opportunity to do good,” he said.
Disclosures should be discussed for verified medical errors, or errors that led to harm, and requires structure and planning, he said. Coaching and roleplaying are beneficial to hospitalists to prepare for disclosures, Hamilton noted.
“All unanticipated outcomes of care should be discussed with the patient,” he said.
“A relationship focused approach is critically important to success when disclosing medical errors,” he added.
When disclosing medical errors, it is also imperative that hospitalists convey authentic compassion and say, “I’m sorry,” Hamilton said. Saying “I’m sorry” is encouraged because it is an expression of empathy, he said.
“If litigation occurs, we want the jury to know that we said we were sorry and were transparent about what happened,” he said. “There is nothing to fear in saying ‘I’m sorry’ — you actually want that out there. We don’t want patients to say, ‘you never told us, you lied to us.’”
Hamilton noted that it is not just the words that matter; it is equally important how the room is set up and how a hospitalist pauses and listens, he said.
Disclosing medical errors with patients is a “skill set and an art form,” he said.
Hospitalists should provide patients with truthful, accurate, fact-based information; emotional support, including an apology; and follow‐up, which may include compensation, he said.
Hospitalists should be prepared to not be “forgiven” and anticipate potential reactions, such as quiet anger, loud anger, sarcasm and sadness, Hamilton noted.
After the disclosure discussion, hospitalists should receive emotional support, he said.
“The moral distress that’s created when we’re waiting for the disclosure to happen is not to be underestimated,” Hamilton said.
Disclosure is a team sport and should not fall on one individual, according to Hamilton. Having a system that is supportive of the disclosure process is important, he added. Everyone on the quality team, from the risk group to the law department, must be on the same page at the same time, he said.
“This is a process and a journey. … When done well, it is a conversation done with a family and patient over time. We don’t always do it perfectly, but when we do, everyone is better off. It’s not about if we do it, it’s about how we do it,” Hamilton said. – by Alaina Tedesco
Hamilton AC. Hard for me to say I’m sorry: Best practices in medical error disclosure. Presented at: Hospital Medicine 2019. March 25-27, 2019; National Harbor, Md.
Disclosure: Healio Primary Care Today was unable to confirm relevant financial disclosures prior to publication.