Current guidelines may emphasize disclosing when errors occur, but don’t offer guidance on how to approach those issues. There has been data suggesting good communication could reduce lawsuits related to adverse events.
The authors of this article recommend clinicians approach these issues carefully:
1. Don’t use the patient’s medical record to raise concerns — it could transgress the “norm of loyalty even more than a direct conversation” and leaves evidence for a malpractice suit.
2. Obtain the facts of the situation before initiating a disclosure conversation and give your colleague a chance to correct mistaken assumptions and join the disclosure.
3. Don’t jump to conclusions and judge your colleagues before conducting the investigation.
4. Go into discussions with colleagues to establish what happened and develop a plan to communicate that to the patient instead of beginning with accusations.
5. Place the responsibility for disclosure on the clinician with the strongest ongoing relationship with the patient. Also consider which clinician has the most experience with complex situations, such as information involving multiple institutions.
6. Consider jointly disclosing key information to patients.
7. Utilize a disclosure coach to facilitate peer-to-peer discussions. Many institutions are developing such programs.
8. Enlist a quality expert for a “curbside consult” to minimize the fear of a punitive review process.
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