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Case: How to Disclose Medical Errors to a Patient's Family



Do your clinicians have a plan for how to address a patient’s family if a medical error occurs?

Consider this true case that was shared with me by a California risk manager – a routine test that goes tragically wrong:

"Mrs. Woods is a 53-year old woman who goes to the hospital for a CT-guided biopsy of the liver. The staff assures Mrs. Woods the test is ‘no big deal’ so she tells her husband to go across the street to do some shopping during the test. The clinical team assures Mr. Woods they will call him when the test is complete. Mr. Woods is standing in Macy’s when his cell phone rings … he answers to hear a nurse frantically screaming, 'Come quickly!' Mr. Woods races across the street to the hospital where he learns his wife is dead."

After reading this case in my training programs, I challenged my healthcare audiences with the following: 

"For the sake of role-playing, let's pretend I am Mr. Woods. I was planning to take my wife home and enjoy a quiet evening, but instead, I will be going to a funeral home because a routine procedure went tragically wrong. What are you going to say to me?"

Usually, 30 to 60 seconds of awkward silence passes. Somebody may utter a shy "Sorry,” and a few more comments or ideas typically follow – some helpful, some not. Most people look at their shoes hoping not to be called out.

Recently, I had a very honest doctor exclaim the following during the role-play: "We don't know what to say! We don't have any information. We don't know what happened. We don't know if there was an error or not. We just don't know what to say!"

website_author_wojcieszakI applauded this doctor’s very honest answer because it’s so representative of the problem. Doctors and nurses know medicine, and they are very comfortable with data, clinical procedures, science, etc. Take all that away and they feel naked. They haven’t been given the tools and training necessary to navigate these difficult situations with patients and families.

I told the honest doc that my case scenario gives him and other clinicians many things to discuss, but unfortunately, the case doesn't provide any of the usual data you like to talk about. The woman is dead, the medicine failed us (either through God's will or error), the husband is devastated, and so is the staff. Plenty to talk about, just not what’s in your comfort zone.

Let’s break down how to approach this situation:

  • We first engage Mr. Woods with empathy and meet immediate emotional needs. You need to spend whatever time is necessary with Mr. Woods (other patients/families can wait; colleagues will cover for you). Much of the time spent with Mr. Woods may be in silence, saying nothing at all. I once heard a police chaplain describe this quiet time as "The ministry of the presence."
  • Consider things you can do such as help make phone calls or provide food, drinks or tissue boxes. Does Mr. Woods want a minister or social worker? You can’t “fix” that Mr. Wood’s wife is dead and you most likely are not ready to discuss the medicine (even if pressed by Mr. Woods), but there are many common sense, compassionate acts you can offer.
  • During an appropriate moment, promise a review and schedule a follow-up meeting right then (3:00pm tomorrow afternoon?).
  • Stay connected with Mr. Woods going forward. Exchange cell phone and e-mail addresses and encourage Mr. Woods to call or e-mail with any questions. If dealing with a large family, try to identify a level-headed spokesperson.

Next time you have a gathering of doctors and nurses at a staff meeting, grand rounds or something similar, throw this case up on a screen and assume the role of Mr. Woods. I promise you will receive valuable data about the state of your disclosure efforts.



Originally appeared on the Sorry Works! blog.



Categories: Communication & Resolution, General Risk Management, Medical Error


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