Can We Be Honest When Medical Error Occurs? Part 2

In my last post, I shared the story of a wrong-sided surgery case I was a part of while a resident. It is a case that has stayed with me throughout my career, shaping my career as a caregiver. To this day, I wish I had chosen to be courageous, and been truthful with that patient instead of taking the easy road–a road well-paved by medical educators of my generation. Resident physicians, however, were and still are, very low on the healthcare power gradient. Everything they do is scrutinized and evaluated. One mistake, one incorrect decision, one slip of the tongue can keep a resident from a top fellowship choice, or a first attending physician position at their favorite hospital. I am fully aware, as my intuition told me so many years ago, that had I been honest with this particular patient at that point in my career with the defining culture present at the time, it is unlikely that I would be writing this post reflecting on a lengthy career in medicine. The culture was, and still is in many places, to deny and defend if necessary.

Like many medical educators with this type of experience behind us, we now hope to create a healthcare system that allows us to be open and honest with patients when unintentional harm occurs. Not only is this the right thing to do, it prevents current and future medical students and resident physicians from being put in this untenable position.  Caregivers want to be honest with their patients but are limited by the prevailing culture of medicine–scared of the consequences and the unknowns painted by others. Many legal consultants advise us that, “It is a mistake to admit a mistake.”  For the past thirty years, caregivers have been told to stay quiet and let others use these tactics to best defend the hospital, however there is no rational data to support this unprofessional and seedy approach.

The following are still very real barriers that prevent caregivers from being open and honest when care unintentionally causes harm:

1. Damage to one’s reputation
2. Loss of license or career
3. Fear of litigation
4. Culture that blames individuals when system errors occur (“Shame and Blame”)
5. Loss of control
6. Lack of training on how best to handle these difficult conversations
7. Uncertainty/Unknown

However, a growing body of research now shows the following benefits can occur when caregivers are open and honest:

1. Maintain patient/family trust
2. Reach remedy agreements in less time without having to use court system
3. Higher percentage of remedy going to patient and families
4. Lower number of claims
5. Learning from mistakes
6. Improving safety for future patients
7. Increased employee/staff morale
8. Psychological well-being of caregivers
9. Accountability for those caregivers who are reckless
10. Financial savings (e.g. decreased legal and administrative fees, malpractice costs)

More and more data continues to be published demonstrating the many benefits that can come from an open and honest approach to patient harm.* Through transparency and adoption of just culture principles, health systems are now learning from these unfortunate events and in turn, making care safer so that others will not experience similar harm. This is the hallmark of any high reliability industry mindset, and long overdue in medicine.

These new results allow healthcare professionals to educate the young, our next generation of caregivers, in every sense of the word. It allows us to be role models  that set an example of what it means to be a true professional caregiver and healer–one who is caring, compassionate and patient-centered at all times, not just when it is convenient. It moves healthcare away from the decades of deceit experienced by patients and families at critical times of need. It moves us away from a culture that built a “Wall of Silence”** between us and our patients when unintentional harm occurred. We can now educate and train future caregivers about the benefits that come from true transparency and the power of open, honest and professional communication with our patients and families. That has been our mission for the past four years at the Telluride Patient Safety Summer Camps.

*For more information see: Liability claims and costs before and after implementation of medical error disclosure program. Kachalia et al, Ann of Int Med, August 2010 and Responding to patient safety incidents: the seven pillars. McDonald et al, Qual Saf Health Care, Dec 2010).

** by Rosemary Gibson