(Excerpted from Journal of Healthcare Risk Management, Volume 27, Number 3)
Patients and their families have certain expectations after an adverse event. They expect acknowledgement, an apology, the complete facts, assurance and possible compensation.These expectations provide a framework of understanding for the actions health professionals need to take to manage errors and adverse events in an empathic and patient-oriented fashion.
How a healthcare professional manages communications after an adverse event can determine the subsequent actions of patients including formal complaints or proceeding to litigation. However, when an adverse event occurs, the doctor should immediately notify and seek advice from his/her insurance carrier. "Adverse" communication following an "adverse" event can potentially complicate the defense against a claim.
Although there are not clear cut, one-size-fits-all rules, how adverse events are managed can determine the subsequent actions of the patient. Remember, it is always best to contact your insurer for guidance whenever an adverse event occurs.
Many patients do not express a desire for financial compensation. They recognize genuine contrition and human fallibility often occurs in complex medical situations. In some cases litigation is financially motivated, but that is not always the primary or overriding reason. Recognizing significant financial stressors of healthcare, some believe that early offers of financial compensation can mitigate the anxiety and subsequent anger from a patient or family. For example, some private hospitals ensure that the patient has no out-of-pocket expenses after an adverse event.
Patients do not want others to experience similar errors or adverse events. They are concerned with standards of care and exploring why they suffered an adverse outcome in order to help prevent others from suffering the same fate. They need real and demonstrable assurances that changes have taken place or will be put into effect.
Patients are entitled to all the pertinent facts related to their health. The historical "paternalistic" fashion of medicine does not work well with today informed patients. Patients need an explicit statement that an unanticipated adverse event has occurred, including a simple description of what happened and how it occurred. Even if the healthcare provider does not have complete information or understanding, communication with the patient should not be delayed, as it is very important that the patient feel "in the loop".
If complete details take time to acquire, be sure to follow up on the details with the patient. Despite "apology legislation" and the development of a standard for open disclosure, there remains confusion as to what constitutes a genuine apology and what a health professional should say in the face of an adverse event. Plus, most medical defense organizations discourage frank and open apology, advocating a more cautious approach.
Research has shown that there is a positive relationship between the showing of remorse and the acceptance of an apology. Apology without remorse is likely to be rejected. Understand that even after a categorical apology, not all patients will be forgiving even if the professional acted ethically, professionally and appropriately at all times.
In healthcare, as in other aspects of life, people want to know when something happens that affects them. Research into errors and adverse events has found that over 95% of individuals want to be informed, even when they have not suffered any harm from a medical error or near miss. The one thing that will cause more problems than anything else is the appearance of a "cover up". Additionally, acknowledgement of the event also requires acknowledgement of and empathy with the emotions that the patient is experiencing.
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