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Talking with Patients and Families about Medical Error

A Guide for Education and Practice

Robert D. Truog, M.D., David M. Browning, M.S.W., B.C.D., F.T., Judith A. Johnson, J.D., and Thomas H. Gallagher, M.D. foreword by Lucian L. Leape, M.D.

Publication Year: 2011

More than a million patient safety incidents occur every year, and medical error is the third leading cause of death in the United States. Illuminating the experiences of those affected by medical error—patients, their loved ones, and physicians and other medical professionals—Talking with Patients and Families about Medical Error delves deeply into the challenges of communicating honestly and openly about mistakes in medical practice. Based on guidelines from the Institute for Professional and Ethical Practice and the authors' own experiences, the practice-based approaches outlined here offer concrete guidance on • initiating discussions • dealing professionally and compassionately with patients' reactions • who should be included in the conversation • what information should be documented in the medical record • how to respond to questions about financial compensation Aimed at promoting resolution and healing, this book stresses the importance of clear, empathetic communication that will improve clinical and organizational responses to medical missteps and mismanagement. It emphasizes five features of the physician-patient relationship deserving of special attention: transparency, respect, accountability, continuity, and kindness (TRACK). Narrative examples of common situations demonstrate how conversations about medical error can lead to healing.

Published by: The Johns Hopkins University Press

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Front Matter

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pp. v

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pp. vii-ix

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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pp. xi

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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pp. xiii-xix

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 ...

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1. Medical Error through the Eyes of Clinicians, Patients, and Families

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pp. 1-9

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 ...

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2. What Is a Medical Error?

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pp. 10-15

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 ...

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3. A Brief Overview of the Patient Safety Movement

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pp. 16-30

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 ...

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4. Communicating about Adverse Events and Medical Error

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pp. 31-56

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 ...

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5. Supporting Clinicians in Disclosure: The Coaching Model

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pp. 57-63

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 ...

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6. Practice-Based Learning for Coaches and Clinicians

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pp. 64-73

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 ...

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7. Practical Guidelines for Disclosure

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pp. 74-91

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 ...

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8. Learning through Enacting

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pp. 92-102

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 ...

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9 The Broad Spectrum of Adverse Events and Medical Error

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pp. 103-117

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 ...

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10. Organizational Strategies for Improving Disclosure Practice

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pp. 118-130

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 ...

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11. Future Directions and Closing Thoughts

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pp. 131-137

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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pp. 139-140

Annotated Bibliography of Key Works

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pp. 141-154


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pp. 155-166


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pp. 167-172

E-ISBN-13: 9781421401027
E-ISBN-10: 1421401029
Print-ISBN-13: 9780801898044
Print-ISBN-10: 0801898048

Page Count: 200
Illustrations: 5 line drawings
Publication Year: 2011