Disclosing harm from a healthcare delivery event
Healthcare providers seek the best possible clinical outcomes for their patients. However, even with the best medical care, a patient's outcome may not be what was originally desired or anticipated. Unexpected changes in a patient's clinical condition most often reflect the worsening of the disease. Harm can also occur through the delivery of care itself, usually from the inherent risks of investigations and treatments. Sometimes, however, an event or circumstance results in unnecessary harm to the patient – this is called a harmful patient safety incident. Patient safety incidents result from system failures or issues in the performance of individual healthcare providers.
Patients expect to be informed about harm they have experienced, whatever the reason for it, and this information needs to be delivered in a caring manner. Effective communication with patients and the healthcare team can improve patient outcomes and satisfaction. Conversely, failures in communication may lead to patient harm, misunderstandings, complaints, and lawsuits.
Healthcare providers have an ethical, professional, and legal obligation to disclose harm from healthcare delivery to patients. The Canadian Medical Association’s Code of Ethics states physicians must "take all reasonable steps to prevent harm to patients; should harm occur, disclose it to the patient."1 In Québec, the Code of Ethics of Physicians states the doctor must "inform his patient or the latter’s representative of any incident, accident, or complication which is likely to have or has had a significant impact on his state of health or personal integrity."2
While advances have been made in training physicians on how to disclose patient safety incidents to patients, ongoing support and guidance is needed. The Canadian Medical Protective Association (CMPA) has published information guiding physicians on how to meet the clinical, emotional, and information needs of patients if an unanticipated poor clinical outcome or patient safety incident has occurred. The CMPA offers practical suggestions to help communicate with patients and the patient's family in these circumstances. Physicians should also be familiar with and follow any relevant guidelines or standards regarding disclosure set out by their medical regulatory authority (College) or their healthcare institution.
The CMPA encourages members to disclose all patient safety incidents to patients and families. Patients should be informed about harm they have experienced, whatever the reason for it, and this information should be delivered in an effective and caring manner.
The CMPA has published the following resources on disclosure:
- Disclosing harm from healthcare delivery: Open and honest communication with patients
- CMPA Good Practices Guide, Adverse Events Disclosure
- Canadian Medical Association [Internet]. Code of Ethics, 2004. [cited 2016 Feb 8]. Available from https://www.cma.ca/Assets/assets-library/document/en/advocacy/policy-research/CMA_Policy_Code_of_ethics_of_the_Canadian_Medical_Association_Update_2004_PD04-06-e.pdf
- Collège des médecins du Québec [Internet]. “Code of ethics of physicians,” Article 56. [cited 2016 Feb 8]. Available from http://aldo.cmq.org/en/Partie%201/AspecDeonto/DevoirObligations/~/media/Files/ReglementsANG/cmqcodedeontoan.pdf