Disclosing Adverse Events: 3 Vital Steps for Physicians

Physicians know they have an ethical responsibility to inform patients when medical errors cause harm. When adverse events occur, physicians need to inform the patient of all the facts to ensure that the patient has a full understanding of what happened, according to ethics guidelines published by AMA.

In addition, the AMA says the concern about the physician's legal liability after full disclosure should not prevent the physician from communicating honestly with a patient. The problem with communicating fully with any patient harmed in the medical system is the understandable concern of malpractice litigation. Given that many physicians will experience a malpractice claim at some point in their career, the way a physician communicates adverse news is of paramount importance.

Experts advise physicians that the way they deliver the information will make a significant difference in how the patient responds. Studies of programs where physicians are encouraged to disclose errors to patients show that malpractice risk and related costs decline. There are now continuing education programs, some through your malpractice insurer, suited specifically for physicians related to communicating effectively with patients in order to reduce risk.

In June, BMJ Quality & Safety published the findings of a survey of almost 700 patients which indicates a correlation between higher likelihood of malpractice claims and patients who do not believe physicians are holding themselves accountable for negative outcomes. The survey suggests that if the patient perceives the physicians is being disrespectful, communicates poorly, or tries to hide fault, then liability risk rises. Furthermore, the study noted that of those patients who pursued a legal solution, 27 percent reached the settlement phase and 17 percent received compensation.

Given these facts, physicians should consider taking at least these three steps to ensure that the process of disclosing the adverse event goes as well as possible.

1. Consult with your lawyer or group's legal counsel. Any physician concerned about an adverse event will need to consult a lawyer and it may be best to do so first, even though some insurance brokers may want to get the first call.

2. Consult with your liability insurer or insurance broker. Frequently, brokers will know where physicians can get the best advice about how to proceed and how to ensure that your coverage is adequate.

3. Look for a way to communicate with patients honestly and with empathy but without admitting guilt.

These are the basic steps to follow, but there's one more that while not necessary from a legal liability standpoint, is likely to improve the patient interaction. Consider that while the physician may feel most responsible for any medical error, in fact, many errors are the result of system failures. For example, some medical schools recognize that often teams of providers cause adverse events that are not attributable to the actions of one individual. As a result, many other providers besides doctors are learning to engage with patients to discuss the errors that lead to adverse events, thus helping bolster the more detailed discussion the physician has directly with the patient.