Talking with Patients and Families about Medical Error
A Guide for Education and Practice
Publication Year: 2011
Published by: The Johns Hopkins University Press
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The driving concept behind the modern patient safety movement is simple and powerful: errors are caused by bad systems, not by bad people. Actualizing this notion has proceeded in two major directions: creating a non-punitive environment where it is safe to report and talk about ...
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In offering this guide to talking with patients and families about medical error, the authors would like to acknowledge and thank all of those patients, families, and professionals who have contributed to the effort to promote transparency, accountability, and fairness in the response of ...
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Over the past decade or so, issues of patient safety and the prevention of medical error have become one of the most important topics in the practice of medicine. The shocking discovery that medical error is one of the leading causes of death in the United States has gal vanized the medical ...
1. Medical Error through the Eyes of Clinicians, Patients, and Families
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We begin with a story that illustrates dramatically the impact of medical error on patients and families. It involves a professional violinist who had been diagnosed with colon cancer. The following dialogue is taken from separate interviews with the patient, prior to his ...
2. What Is a Medical Error?
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This book is about difficult conversations that occur in the aftermath of adverse events and medical error. In order to properly frame the principles and guidance that we recommend, however, some background discussion of definitions, historical considerations, and conceptual ...
3. A Brief Overview of the Patient Safety Movement
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Of course, medical error is not a new problem; it has existed since the first injured or sick patient sought medical care.20,21 However, the evolution of health care into a complex system, involving multiple specialties, teams of clinicians, different sites of care, and new technologies and medications, has ...
4. Communicating about Adverse Events and Medical Error
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Lucian Leape has championed the importance of disclosure and apology on the solid ethical grounds that it is “the right thing to do,” and indeed, that should be suffi cient. However, in a world in which clinicians fear that a single error could bring ruin to their professional reputations and financial ...
5. Supporting Clinicians in Disclosure: The Coaching Model
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The increasing emphasis on the importance of disclosure over the past few years has led many organizations to undertake programs to develop policies and procedures, as well as to begin educating their health care workers about this issue. At Harvard, the emphasis on disclosure was renewed in 2006 when ...
6. Practice-Based Learning for Coaches and Clinicians
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In designing an educational curriculum for disclosure, our task was to craft learning activities that would incorporate the values, skills, and knowledge relevant both to having conversations with patients and families in the aftermath of adverse events and medical errors and to helping clinicians prepare for such ...
7. Practical Guidelines for Disclosure
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In developing practical guidelines to assist and support coaches and clinicians, we began by reviewing and incorporating the information already available in the literature. Not surprisingly, a review of the ethics literature, empirical studies, and institutional policies suggests that while certain differences in approach exist, there is ...
8. Learning through Enacting
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After coaches and clinicians have been exposed to the core relational values, knowledge base, and just-in-time guidelines for the practice of disclosure, it is important to have an opportunity to see practice in action and then to refl ect on that practice. In our workshops, we aim to achieve depth by enacting one ...
9 The Broad Spectrum of Adverse Events and Medical Error
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Adverse events and medical error occur across a broad spectrum, from those that involve little or no harm to those that are catastrophic. In this chapter we explore how cases vary across a range of variables, such as differences between the inpatient and outpatient settings and between medical, surgical, and psychiatric ...
10. Organizational Strategies for Improving Disclosure Practice
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Improving communication in the aftermath of medical errors and adverse events will be successful only if it is part of a forward-looking organizational approach to promoting a culture of safety. Likewise, patient safety efforts, to be efficacious, must be part of a comprehensive strategy of organizational learning, which ...
11. Future Directions and Closing Thoughts
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How clinicians communicate with patients and families in the aftermath of adverse events and medical errors has changed substantially over the past decade. At the same time, in many respects, competent and responsive disclosure practice is still at an early stage. Over the next several years, it is ...
Appendix: Practical Guidelines for Disclosure
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Annotated Bibliography of Key Works
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Page Count: 200
Illustrations: 5 line drawings
Publication Year: 2011