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Disclosing Medical Errors to Patients – To Do or Not to Do?

Submitted by on July 15, 2014 – 9:25 PM

disclosureDisclosure of medical errors has become a controversial issue in different hospital settings. The matter of declaration of mistakes is considered destructive but it is better to disclose and settle error at its root before it generates a series of problems. It’s a good saying that “Facts cannot be concealed by any one.” Significance of disclosure errors is that they provide ways to resolve the error straightaway for patient safety.

 

This is a true story of a patient who mistakenly received injection verapamil 5mg on pressures of 80/50mmHg. Patient was then found to be unresponsive as his pressures dropped drastically and was resuscitated. Medical error is a failure of an intended action to be completed as planned or irresponsible actions that harm the patients (Shaikh & Lalani, 2011). So, I got a strong hold that it should be disclosed to patients because it is beneficial for them, our moral obligation and the legal responsibility of health care professionals.

 

Declaration of medical error is beneficial for patients in many ways. Firstly, it helps to keep the patient updated about his/her condition. Once an error is committed, patient has a right to know about all outcomes of this error. After declaration, patient will know what treatment modalities are being planned for the error that has occurred.

 

Secondly, patients need to know the consequences of errors, which will be helpful in making informed decisions regarding their further treatment based on the medical facts of their present situation. Thirdly, disclosure helps in patient’s recovery by determining early interventions, and ultimately lessens the expenses. The prompt action of medical professionals towards the error disclosure is highly appreciable which can save patient’s life and will decrease the patient’s length of stay.

 

However, opponents would argue that disclosure will exaggerate family’s anger and frustration if an irreversible error has been made, like death of patient. Aggression of patients towards health care team is considerable in their point of view, as malpractices are not appreciated in any hospital setting. Moreover, it will break trusting relationship between the client and their care provider. Patients and families will not trust the professionals in regards to the care being provided and their rapport will get damaged.

 

Furthermore, disclosure will cause emotional distress among patients and families as they will be stressed out by thinking the outcomes of errors. Still we should disclose errors because a conscious patient can take their own decision to continue care at the same hospital or not to minimize further risks. Likewise, the fear of breaking trusting relationship can be settled by an apology which counts a lot in rebuilding trust towards the profession, as apology is an influential communication that recognizes the misery of a patient.

 

Next, medical error disclosure is the moral obligation of paramedical staff (Shaikh & Lalani, 2011). In order to strengthen open communication, it’s the staff’s duty to tell the truth and respect the patient’s right to autonomy. As patients have a right to know everything about their health and if error has endangered their life, will be a serious violation of their right to autonomy. According to the code of  ethics, fidelity is also a moral obligation which means to be truthful to patient and not disclosing the error and hiding patient’s vital information from them would disrespect patient’s right to fidelity. Furthermore, failing to disclose an error would breach the principle of veracity because if we fail to convey the information to recipient or if it misleads them, so this comes under violation of veracity.

 

Error disclosure will increase patient’s anxiety and frustration and we will harm them instead of doing well. In critical circumstances, sometimes leaders prefer not to disclose an error because that will further deteriorate patient’s condition. Some patients overcome the stress with anger and can create danger for others, which is unethical. Another ethical concern is that staff saves themselves by giving false assurance to patients that they will be fine or the situation is under control.

 

Additional reason of not disclosing error is the fear of malpractice claims even after communicating truly and honestly. Sometimes physicians do tell openly about adverse events but patient disagree to that and it leads to malpractice claims. Despite of this, if errors are disclosed properly by any trained professional so it will not cause violence. Therefore, it should be disclosed in a manner that patient and their families are well supported. And we should not forget nursing code of ethics which also teaches us to respect patient’s dignity and their rights to improve relationship with them.

 

Finally, it is the legal responsibility of staff to disclose error to refrain from litigation. If errors are not disclosed openly so it can lead to organizational sue. Medical professionals have taken oath to not to harm their patients, so to fulfill their oath they must justify their legal responsibility. Patients and their families not only want error disclosure but also want to know how it occurred, how their loved ones can be treated and finally a sincere apology is needed.

 

Moreover, disclosing of error fosters client’s trust towards profession and they will willingly cooperate with the treatment ahead. It is suggested to disclose the error by keeping in mind the organizational policies. Joint Commission on Hospital Accreditation has made a standard in place that patient should be informed about the whole condition and unanticipated outcomes (Levinson, 2009).

 

In contrast, an error disclosure in hospital setting develops negative image of an organization. Family can litigate organization and can demand for compensation. Disclosure of medical error is considered as handing over a ‘blank check’ and invite lawsuits for compensation and damage to the institution’s reputation (Clark, 2010). After confession of error, patients and families will not suggest others to go to same hospital and it will automatically down the revenue of hospital.

 

The blame of an error can threat other department and unit staff because the management will be more conscious about errors and will pressurize their staff for the perfection. If we keep aside fear of litigation and can see from the patient’s perspective, so they actually want a clear and transparent communication from health team to prevent this error in future, and this true communication will actually help to improve standards and reputation of an organization.

 

In conclusion, despite of the arguments on not to disclose the error, I still support that errors should be revealed to patients as it is helpful for them, is ethical and lawful commitment of paramedical staff to ensure best outcomes for patients. Nonetheless, respecting patient’s right to live and right to know about the treatment holds an important place in ethics and should be respected because it has benefits and helps patients to live a healthy and a respectable life. So for this purpose, it is recommended that frequent training sessions should be arranged for paramedical staff on different policies and standards, frequent audits must be planned to detect any mishaps on the spot and team leaders are required to pay their full attention on interns and provide them clear directions to improve quality care so as to prevent extra medical expenditure of patients, effect on professional life of staff and stigmatization of an organization.

 

 

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