Disclosure of Medical Error
When making a medical mistake and causing harm to the patient, it is quite understandable that the medical personnel want to hide this fact, first of all - from the patient. However, hiding medical errors brings a lot of harm for the following reasons.
1. The trust of patients and society towards doctors is undermined.
2. The patient can be hurt even more, which could be avoided. Since the patient does not know the cause of his condition, he can not adequately be treated (for example, in another medical institution).
3. Patients can not give full informed consent for further treatment.
4. In a medical institution, a morally unacceptable situation is created. Since doctors can not be honest with patients, this will inevitably affect the quality of care in the future.
5. Having found out later about the harm done (for example, in another medical institution), the patient receives a moral trauma, because he feels that he was deceived, etc.
The issue of disclosure of information causes a lot of controversy. First of all, an argument is made against the disclosure of information, which is that it is better not to tell the patient (if it is possible) nothing for his own good, so as to cause him additional suffering. They refer to the traditional medical privilege, which allows you to hide information from the patient in his interests. It is also believed that disclosure of information can undermine a patient's belief in medicine, make them question doctors, be treated, etc.
Of course, the costs of disclosure of information exist. But in general, the provision of information to the injured patient still becomes today a generally accepted practice. In a number of developed countries special measures encourage the practice of medical institutions and doctors to disclose information.
Of course, the affected patient needs to be provided with immediate medical care. Further management of patients who are harmed requires attention and tact. If the patient continues to be treated in this institution, additional measures for care, psychological assistance, treatment and rehabilitation should be provided for him.
What is the best way to disclose information to a patient and, if necessary, to his relatives?
First of all, when deciding on this, you must always act out of the interests of the patient. Affected patient should be protected, not to exacerbate unnecessarily his physical and psychological suffering.
Disclosure of information must be commensurate with the harm done or the risk that exists. To do this, one must be guided by common sense. If the error is insignificant, and the harm done is rather small and corrected, then there is probably no special need to disclose the information. In addition, unnecessary details of the error, if the information about them does not affect the quality of further assistance, are also unlikely to be useful to the patient. In general, the disclosure of information and its detail are determined by how significantly the medical error affected the course of treatment and disease.
If the doctor is having difficulty with the alleged disclosure of information, it is recommended that you first consult your colleagues, with more experienced doctors.
In order to disclose information, you must choose the right time and the right conditions. It is desirable to achieve a stable state of the patient and a suitable time for conversation with him. It is also necessary to choose an adequate form for informing. It is necessary to apologize to the patient, and also in a calm tone to explain what happened and why, trying not to blame anyone (first of all, the patient himself) and not defending oneself in advance from possible charges. All this must be done in a confidential, sincere form. In this case, disclosure of information is unlikely to undermine the patient's confidence.
Based on the circumstances, it is also necessary to decide who will participate in the disclosure of information. Either it will only be the attending physician, or you can invite someone else, such as your supervisor, a representative of the hospital administration, etc.
If the patient wishes to receive an independent second opinion or advice from other doctors or medical institutions, he has the right to do so. Moreover, in specific circumstances, it may even be appropriate that the doctor himself suggests that the patient be more confident in obtaining an independent opinion. In addition, if medical care is required to correct the consequences of causing harm (or some other help), then it is necessary to offer it to the patient; it is advisable to do everything possible to mitigate iatrogenic effects.
A favorable impression can also tell a patient about what will be done in a medical institution, in order to avoid repetition of such cases in the future.
If the patient is emotionally traumatized, then it is necessary to obtain information about this through specific questions. In this case, the patient should also be provided with appropriate psychological (psychotherapeutic) help.
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