Question of the Week

For July 15, 2014

Your answer is correct.

Explain that nephrotoxicity is a known side effect of cisplatin Explain the error now, and apologize to the patientPostpone discussion of the error with the patient until a full investigation of the circumstances leading to the error has been completed Get advice from the hospital’s ethics consult serviceAsk the hospital attorney to meet with and apologize to the patient

Key Learning Point View Case Presentation

The proper way to communicate an iatrogenic medical error that causes harm to a patient is to provide an early, open, honest account of the error and apologize formally to the patient.

Detailed Feedback

Although physicians might be reluctant to disclose errors because they are embarrassed or fear litigation, telling the truth shortly after the error is discovered is ethically obligatory and is the accepted standard of care. Acknowledging a medical error and apologizing for it is only the first step in managing the error; health care systems also need to identify the root cause and address knowledge and system gaps to ensure that the error is not repeated. However, initial discussion with the patient and acknowledgement of the error should not be delayed while the investigation is ongoing.

The National Quality Forum recommends that when disclosing a medical error, a physician should provide relevant information surrounding the events, express regret for the unanticipated outcome, and give a formal apology.

Lying or attributing the cause of the error to another etiology is unethical; it is the treating physician’s responsibility to disclose the error and apologize for it.

Although the hospital attorney or risk-management team will usually become involved in cases like this, it is the attending physician’s responsibility to acknowledge and discuss the error with the patient.

An ethics consultation might be helpful later on if an ethical dilemma arises, but it is unnecessary at this stage.

Last reviewed Dec 2016. Last modified Dec 2015.

Citations

Gallagher TH et al. Disclosing harmful medical errors to patients. N Engl J Med 2007 Jun 29; 356:2713. > View Abstract

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