Originally published October 2014
Within the context of the wired world, physicians can expect that harm to patients from healthcare delivery, including patient safety incidents (called accidents in Québec – see Terminology), may be shared through social media and potentially through traditional media such as newspapers, radio, and television. When more than one patient is harmed, the media interest typically grows and the likelihood of social media exposure expands greatly.
Patients expect to learn about harm they have experienced, whatever the reason for it. Physicians have an ethical, professional, and legal obligation to disclose this information, and it should be delivered in a caring manner. Patients generally want the facts about what happened, the recommended next steps in clinical care, a genuine expression of concern and regret including a statement that one is sorry for what has happened, and some assurance that steps are being taken to prevent a similar occurrence from happening to others. In addition to disclosure at the time, many patients need ongoing support and information.
When the media is informed
Most patients are reassured and satisfied by an honest and timely disclosure by the physician and other healthcare professionals involved in an event. However, sometimes patients share their experience directly with the news media or on social media. Since traditional media sources monitor social media to identify potential news stories, patients' use of social media increases the likelihood of the news media becoming aware of what happened.
Doctors should anticipate that a harmful patient safety incident (accident in Québec) could become publicly known, and this is more likely if it involves several patients. As a result, physicians should consider developing a strategy to manage the media interest, in consultation with their institution or health authority, when appropriate. If the information is posted on social media, physicians may want to monitor what is being shared, including the general tone and the motivation for sharing.
Proactive media approach
Physicians (and their institution) might contemplate a proactive approach if media interest is likely to be high. With such an approach, the focus should remain on patients, including discussing with them the harm they have experienced and answering their questions.
Shortly thereafter, physicians or the institution's spokesperson may issue a general statement about the facts related to what happened and the measures being taken to learn more through analysis. Affected patients should be made aware of the intended public disclosure. The institution or the doctor can release general information, including the nature of the event, the number of patients affected, and the measures undertaken to remedy the situation, however they must protect the confidentiality and privacy of patients affected. Most institutions have protocols to deal with media interest, and physicians should coordinate their response or role, if any, with the institution.
Although patients have the right to identify themselves as victims of harm from care and grant media interviews, physicians must protect the identity of affected patients. When interviewed, even if the identity of patients is known, physicians should refrain from any specific references that might enable others to identify the patient.
Reactive media approach
If the circumstances are more suited to a reactive media approach, physicians involved should participate in its formulation. This would include who will respond to media inquiries, the name of the official spokesperson, what statement or key messages will be provided, and the format (for example a news conference, a tweet, an email response, or one-on-one interviews).
Again, maintaining patient confidentiality is paramount, even if patients are themselves sharing their stories with the media. As in the disclosure discussion with the patient, physicians should avoid speculation as to the reasons for what happened. This will prove challenging as the media may press for more definitive answers and seek out the affected patients and providers. A well-coordinated and consistent media response will prove most valuable and fair to all concerned.
The most appropriate spokesperson
Whether a proactive or reactive media approach is utilized, it is important to identify the most appropriate individual to speak about what happened. Recognizing the information must be more general than specific in nature, it may be appropriate to rely on a chief of division, a department head, or another spokesperson rather than the physician or other healthcare provider directly involved. However, since each situation is different and circumstances will dictate the most appropriate approach, media relations planning before responding to an enquiry is key.
In addition to their significant concerns for the patient and the family, physicians may understandably be worried about their reputation in these circumstances. Similarly, the institution in which they practise will want to appropriately address the issue and its impact. Physicians should work jointly with the institution or health authority, align messaging, and support a contained media approach. Doctors should avoid speaking on behalf of the institution or health authority unless authorized to do so.
The tone and disposition used by the physician or institution may significantly contribute to the nature of the media coverage. Physicians should avoid defensive, elusive, or obstructive demeanour when facing the media, even when the encounters are unexpected. Expressing empathy for what has happened, remaining calm, and explaining the process for analyzing the event is the best approach.
When addressing patients about harm, or when addressing the media, doctors should communicate with empathy. Media coverage of a harmful patient incident (accident in Québec) can be very stressful for physicians and patients, regardless of whether there may be a future legal action. A measured and compassionate approach on the part of physicians will convey professionalism, and mitigate reputational damage.
Some patients who suffer harm may commence a legal action against the physician(s) involved. Patients may or may not seek media attention in these cases. However, legal actions can harm a physician's sense of worth, well-being, credibility, and reputation — even if the actions are subsequently abandoned by plaintiffs. Sometimes, more than one patient may be harmed or put at risk. This can occur, for example, if there are failures in the system and processes of care, equipment, or an individual provider's performance is questioned.
Just as with other legal actions, class action lawsuits can impact physicians greatly. A physician's reputation is often at stake during these cases because of media coverage, even when there is a failed attempt at certification.1 In either case, media attention can affect a physician's reputation. Class action lawsuits tend to draw instant media attention, and media reports can allow patients and families to voice concerns that the health system, its regulators, or doctors failed them.2
At all times, physicians should carefully consider how to approach media interest. A planned approach to timely and honest communication is also important, and members may contact the CMPA for advice.
Working with the media on large-scale disclosure
Large-scale harmful patient safety incidents (accidents in Québec) are often picked up by media and discussed on social media. Consider, for example, a case in which medical equipment has not been properly sterilized between patients over a number of years. In these cases, healthcare organizations generally coordinate communications with the media, including the public release of information about the event or risk itself, the at-risk patients, and the follow-up process.
Proactive organizations may alert the media before a formal review of the event has been completed. Physicians working in healthcare organizations should be aware of and follow the organization's process for managing multi-patient disclosure to patients and informing the media. Hospitals and institutions may provide briefing sessions and a supporting information package for those providing multi-patient disclosure.
Doctors should also avoid premature, unsubstantiated, or inappropriate remarks, including comments about other organizations or the professional competency of other providers.
The World Health Organization (WHO) provides terminology to facilitate the sharing and learning of patient safety information globally, and this terminology is recommended by the Canadian Patient Safety Institute.
To support clarity and consistency in patient safety discussions, the CMPA now uses these terms:
Patient safety incident: An event or circumstance which could have resulted, or did result, in unnecessary harm to the patient.
Harmful incident: A patient safety incident that resulted in harm to the patient. Replaces the terms “adverse event” and “sentinel event.”
No harm incident: A patient safety incident which reached the patient but no discernible harm resulted.
Near miss: A patient safety incident that did not reach the patient. Replaces the term “close call.”
Terms used in Québec
Québec, the applicable legislation defines the terms “accident” and “incident.” Neither of these corresponds exactly to the WHO terminology. An “accident” in Québec means an action or situation where a risk event occurs which has or could have consequences for the state of health or welfare of the user, a personnel member, a professional involved or a third person. The term “incident,” on the other hand, is defined as an action or situation that does not have consequences for the state of health or welfare of the aforementioned parties, but the outcome of which is unusual and could have had consequences under different circumstances. The term “accident” in Québec legislation would align with the WHO term “harmful incident” whereas the term “incident” would include the WHO terms “no harm incident” and “near miss.”
Lightstone, Susan, "Class-action lawsuits medicine's newest legal headache," Canadian Medical Association Journal (2001) Vol. 165 No.5, p.622