Five ways healthcare systems can help physicians talk about adverse events

For many surgeons and physicians, the hardest thing they will have to do in their medical career is talk to a patient about a medical error.

Although communication and resolution programs are becoming more pervasive throughout healthcare, providing a more structured approach to adverse event discussions, clinicians still struggle when it comes to discussing unintended outcomes with patients and their families. Hospitals and health systems can further complicate the anxiety surrounding these discussions by failing to provide physicians with the necessary support to facilitate open, honest, and effective communication.

In fairness, the discussion around medical errors can be an emotionally charged affair for both physicians and the patient, and one that is nuanced and often cluttered with unresolved or unknown complications. Layered on top of that is a longstanding concern about malpractice lawsuits prompting hospitals and liability insurers to urge physicians to limit their discussions with patients.
 
As a result, physicians and surgeons struggle to communicate key issues during these conversations. According to a study published in JAMA Surgery in July, the majority surgeons surveyed within the Veterans Administration (VA) health system explained why the event happened, expressed regret and concern for the patient’s welfare, disclosed the event within 24 hours, and discussed steps for future treatment. However, a much smaller portion of surgeons apologized to patients, discussed whether the event was preventable, or discussed how reoccurrences could be avoided.

Since the study was voluntary, the surgeons that participated where among the most comfortable discussing adverse events, says Rani Elwy, PhD, lead author of the study and director of the Center for Information Dissemination and Education Resources (CIDER). Elwy is also an investigator at the Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Health Services Research & Development Resource Center in Boston, and a professor in the Department of Health Law, Policy and Management at Boston University. 
 

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