Speaking with patients or their families after a medical error or an adverse medical event is one of the most difficult conversations a clinician can have. Rather than taking a deep breath and walking into this stressful event unprepared, there are some things you can do. Preparing for a difficult conversation can greatly support the interactions between the patient and clinical team, help to reduce the anxiety and stress felt by all involved, and assist the family or patient with the emotional healing needed to move forward. Moreover, the conversation, if done as well as it can under the circumstances, can lead to re-establishing trust with the patient.
Recent research conducted by The Betsy Lehman Center (1), found that only 19% of Massachusetts residents who experienced an error or adverse event said that they received an apology. This group was less likely to feel angry, depressed, abandoned, and betrayed than those who didn’t receive an apology. Well over half of the respondents whose error happened 3-6 years before said that they sometimes or always continue to avoid the doctors or the health care facility involved in the error. Being thoughtful about how the meeting might progress and what the priorities might be, we believe, is well worth your time.
Below are some important and useful tips to help you prepare to have such a tough conversation.
Remember: Before you have any disclosure conversations, you need to know what the current policies and attitudes to disclosure are in your own institution, and confirm any medical/legal issues first (for example, through talking to risk management or the equivalent in your own setting).
Tip 1: Focus on the Purpose
Remember that the meeting with the patient and family is for their benefit.
Tip 2: Consider who Needs to be in the Room
Determine which clinician/provider(s) should be present for the initial conversation and assess who should be available to support the patient and family.
Tip 3: Present a Unified Voice
Before meeting with the patient or family, discuss the need for the team to present themselves in a sincere, unified, and professional manner.
Tip 4: Avoid Blame
Avoid blaming others. For example, saying, “the lab always does this,” or blaming the system is not helpful to the patient, family or institution.
Tip 5: Be Honest, but Don’t Speculate
Think about what you will say to the patient or family about what has happened. Honestly share the facts of the situation, as they are known, with the patient and family. However, resist the temptation to speculate beyond what you know for certain at this point.
Tip 6: Try to Anticipate the Patient or Family’s Needs
Anticipating the patient’s and family’s needs, even practicing the conversation in role play, can be very helpful. Speak with an institutional coach or other resource, as well as risk management (or equivalent) and the team, beforehand to understand your institution’s policies and practices around what to say in disclosure conversations and to anticipate potential questions and emotional reactions from the patient and family. The think through how you might respond to the possible scenarios.
For a more in-depth introduction on this topic take our workshop on Disclosure and Apology after Medical Error and Adverse Events.
- The Financial and Human Cost of Medical Error, Betsy Lehman Center, June 2019
- These tips are based on CRICO’s “Guidelines for Disclosure” developed in collaboration with the Institute for Professionalism and Ethical Practice
This article was updated from its original publication in August 2017 to include new research and findings.