Disclosing Unanticipated Medical Outcomes

Despite the best efforts to provide safe, quality care, sometimes things go wrong and patients might experience harm. When patients are harmed, a disclosure to the patient and/or family is warranted. Communication with patients when there has been a medical error or an unanticipated outcome is difficult, but when the proper techniques are used, patients are less likely to file complaints to a licensing board or file suit.

The most appropriate person to have this discussion with the patient is the provider who rendered care. When the adverse event involves another clinician, the provider should encourage the patient to reach out to that provider.

Careful preparation before having a discussion with the patient and/or patient family is advised and the following four tasks, which should take place immediately following an event, are recommended.

1. Attend to the care of the patient:
   • Charting of facts
   • Preserving material for investigation
2. Develop clarity about what happened
3. Prepare for discussion with the patient and family
4. Address your own emotions and seek assistance if needed

Chart Documentation:

1. Date, time and location of disclosure
2. Attendees/relationship to the patient
3. Facts conveyed re: patient's health status, care/treatment
4. Explanations offered
5. Next steps
6. Transfer of care (if offered or discussed)
7. Offers of assistance (social work, spiritual care)
8. Name of staff for follow-up (ease of contact)

**If you don't want it in the chart, don't say it!
When care is reasonable then an expression of sympathy without further apology should be sufficient. When there is a situation in which the adverse outcome is a direct result of not meeting the acceptable standard of care, the patient is going to want/expect more than an expression of sympathy.

Prudently planning and documenting these conversations is an important step in mitigating risk. Consider having an unbiased witness in the room such as a Risk Manager, Office Manager or a colleague. If a referral to another physician is warranted for further treatment or for a second opinion, contact that physician and be honest about the event and the outcome. This proactive step will all that physician to tactfully handle the situation when rendering his or her opinion.