Providers must talk openly, freely and truthfully with patients and patients’ families about unanticipated outcomes and medical errors, says this year’s presenter of the ABOG Educational Foundation Lectureship on Patient Safety and Quality Improvement.
Patrice M. Weiss, MD, FACOG, executive vice president and chief medical officer at Carilion Clinic and professor at the Virginia Tech Carilion School of Medicine, will address why full disclosure matters to patients, patients’ families, and providers and what barriers to those disclosures exist during “To Tell or Not to Tell — Disclosure of Errors” at 11:30 am today in Hall D. She also will explain the important principles and techniques of disclosure.
“I think providers now understand that you have to be 100 percent truthful and transparent in your disclosure,” said Dr. Weiss, who has been talking about and training others about disclosure for a decade. “That’s really been a big shift over the last 10 years. The problem is that we’re not really trained in how to do it.”
Dr. Weiss will talk about the two key principles of disclosure: truthfulness and timeliness. Even if some of the facts about the case remain unknown or uncertain, providers must tell patients and families what they do know at that moment and, when necessary, apologize and accept responsibility for the outcome.
In addition, the provider needs to make sure all of the appropriate parties in the hospital system know what has happened and make sure that the management of the patient is ongoing. That includes financial and administrative needs, but Dr. Weiss said that the provider should not make promises. Instead, the patient and the patient’s family need to know whom to contact.
“There’s two things patients want from us,” she said. “They want to hear the words, ‘I’m sorry,’ and they want to know what are you going to do to prevent this from happening to anybody else.”
All providers are trained under the credo of “do no harm,” Dr. Weiss said, so unexpected outcomes can cause providers to have emotional responses that make having the necessary conversations with patients even more difficult. The lack of training about how to have these conversations adds to the problems.
All providers need to know what resources their institutions can offer in these situations so that disclosure conversations meet the 100 percent mark in both truthfulness and timeliness.
A study done at a VA hospital in Kentucky found that the initiation of a policy of 100 percent truth and transparency actually decreased payouts for medical malpractice and medical errors.
“We worry that if we tell patients things, they’re going to sue us,” Dr. Weiss said. “Well, the worst thing that can happen is that a patient does seek legal action and then through the medical chart they find out a lot of things that we never revealed to them in the first place. That’s even worse.”