Disclosure: Who, What and Whether To

Each of these scenarios presents a disclosure conundrum. Should there be disclosure when there is an unanticipated outcome without clear linkage to an error? How should you most appropriately disclose an obvious error with unknown damage? What is the correct action when there is a non-consequential mistake that is incidentally detected? Because each situation has unique facts and nuisances, there is no way to provide an exact roadmap.

Disclosure is a ripe topic for discussion but recognized to be in its practical and legal infancy. It is clear that education is the key to overcoming the pitfalls of this process. Outcomes should be measurable based on patient reaction. Because the lack of communication has generally been regarded as a source of patient dissatisfaction, it is reasonable to speculate that disclosure done properly should decrease litigation.

Agnes Yost can be contacted at [email protected].

References

1. Kachalia A, Shojania K, Hofer T, et al. Does Full Disclosure of Medical Errors Affect Malpractice Liability? Joint Commission Journal on Quality and Safety. October 2003. Volume 29 Number 10:503-11.
2. Rosental J, Booth M. Defining Reportable Adverse Events: A Guide for States Tracking Medical Errors. National Academy for State Health Policy. March 2003.
3. Task Force of the American Society for Healthcare Risk Management. Monograph. Disclosure of unanticipated events: the next step in better communication with patients. May 2003. American Society for Healthcare Risk Management of the American Hospital Association.
4. Popp P. How will disclosure affect future litigation? ASHRM J. Winter 2003:5-9.
5. Safety Institute, Premier Inc. Survey on Disclosure Practices in Hospitals. 6th Annual NPSF Patient Safety Congress. Boston. May 3-7, 2004. (ECRI’s Healthcare Risk Control Weekly News. July 7, 2004).
6. Gallagher T, Waterman A, Ebers A, et al. Patients’ and Physicians’ Attitudes Regarding the Disclosure of Medical Errors. JAMA. 2003;289:1001-1007.
7. Apologies lead to trust, healing, help avoid litigation, new book says. Medical Liability Monitor. July, 2004. Vol 29, No. 7.