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Five quick tips to communicate about adverse outcomes

Ambulatory Safety Monitor, July 7, 2004

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How much information should staff reveal when procedures go wrong? And if they provide too much information, will it be used against the physician in court?

Give honest explanations and apologize to patients when procedures do not run smoothly or when patients do not react to treatment the way you anticipate. Know the facts and don't place blame, says Daniel O'Connell, PhD, a consultant for the Bayer Institute for Health Care Communication in Washington.

This strategy may help reduce your malpractice claims. O'Connell says patients often file malpractice suits against physicians because they feel the physician deliberately withheld information, they feel the physician refused to apologize for what happened, or they do not believe that the facility will prevent the problem from happening to another patient.

O'Connell led a seminar on how to discuss negative outcomes at the JCAHO's 8th annual ambulatory care conference in Chicago last October. When talking to patients, he said always keep in mind what you would want a physician to tell you if something went wrong with your child's treatment. He offered physicians the following tips:

• Talk about a negative outcome with the patient as soon as possible
• Empathize with patients and reassure them that your facility wants to correct the problem
• Apologize to the patient but don't blame other staff for the mistake
• Cooperate with the patient as much as possible and explain the situation in a way that makes sense to them
• Don't make up explanations if you don't know what caused the unanticipated outcome

In these difficult cases, O'Connell urges your organization to require all physicians to discuss the issue with a risk manager or medical leader before talking to the patient. This will help them decide on the best strategy.

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