Clinical Outcomes, Disclosing Unanticipated: A Resource Guide for Family Physicians (Position Paper)
Health care literature is replete with studies documenting the occurrence of clinical errors in hospital and office based medical practice. It is widely accepted that patients should be informed when errors occur. Standards promulgated by the Joint Commission make this an explicit requirement in the hospital setting. The question physicians must ask today is not whether to disclose a clinical mistake, but how to share the information. Many physicians are not familiar with the results of coordinated efforts by some health care organizations to institutionalize the disclosure of medical mistakes. By and large, these efforts have been quite positive in helping patients come to grips with the clinical consequences of a clinical error, aiding physicians who may be plagued by guilt following the occurrence of an error and in ameliorating liability costs. A number of organizations, such as Sorry Works! (described below) have been created to assist physicians to communicate effectively with patients under the emotionally laden circumstances of a clinical error.
The Bibliography and Resource List which follows is meant to provide the busy clinician a reference point for learning more about approaches to disclosing medical mistakes. The articles and resources below are best explored before an unfortunate circumstance makes the need compelling. However, they will also be useful for those reaching out for ‘just-in-time’ knowledge. This resource listing is meant to be a useful, but not an exhaustive, guide to the literature on this subject and there is little doubt that additional resources will constantly be appearing.
Sorry Works: The Sorry Works! Coalition is a nationwide organization of doctors, lawyers, insurers, and patient advocates dedicated to promoting full-disclosure and apologies for medical errors as a “middle ground solution” to the medical liability crisis. It has published white papers and protocols for addressing medical errors and it is a major sponsor of legislation at the state level. It has an informative web site at www.sorryworks.net(www.sorryworks.net).
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Cherry RA, Marcus L, Dorn B. Reporting adverse events to patients: a step-by-step approach, Physician Exec J. 2010;36(3):4-6, 8-9. net.acpe.org/MembersOnly/pejournal/2010/MayJune/Cherry.pdf(www.net.acpe.org)(www.net.acpe.org).
Fein SP, Hilborne LH, Spiritus EM, et al. The many faces of error disclosure: a common set of elements and a definition. J Gen Intern Med. 2007;22(6):755-761. www.springerlink.com/content/ag6615m8713342n3/fulltext.html(www.springerlink.com).
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Petronio S, Torke A, Bosslet G, Isenberg S, Wocial L, Helft PR. Disclosing Medical Mistakes: A Communication Management Plan for Physicians. The Permanente Journal. 2013;17(2):73-79. Full text available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662285/(www.ncbi.nlm.nih.gov)
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Roberts RG, The art of apology: when and how to seek forgiveness. Fam Pract. Manag. 2007;14(7):44-49.http://www.aafp.org/fpm/2007/0700/p44.html.
Robbennolt, JK. Apologies and medical error. Clin Orthop Relat Res. 2009. Feb;467(2): 376-382. Full text available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628492/(www.ncbi.nlm.nih.gov)
Rocke D, Lee WT. Medical Errors: Teachable Moments in Doing the Right Thing. Journal of Graduate Medical Education. 2013;5(4):550-552. Full text available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886448/(www.ncbi.nlm.nih.gov)
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White AA, Bell SK, Krause MJ, et al. How trainees would disclose medical errors: educational implications for training programs. Med Educ. 2011;45(4):372-380. Abstract at onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2010.03875.x/abstract(onlinelibrary.wiley.com).
(March Board 2006) (2017 April BOD)