Français

Disclosure


Maintaining trust

Disclosure road map


1. First things first: Attend to clinical care

  • Address clinical needs and deal with emergencies
  • Consider the next steps in clinical care
  • Provide emotional support
  • Document the adverse event

2. Plan the initial disclosure

  • What are the facts
  • Who will be involved
  • When and where will the meeting occur

3. The initial disclosure meeting

  • Provide the known facts
  • Be sensitive
  • Do not speculate or blame others

1. First things first: Attend to clinical care

Address clinical needs and deal with emergencies

The first priority is to stabilize and monitor the patient's breathing.

Seek help as appropriate.

Alert your supervisor of the emergency and the reasons for it.

Consider the next steps in clinical care

Consider whether you are the appropriate individual or team to provide further care after an adverse event (accident in Québec). You should consider transferring the care of the patient for any of these reasons:
  • The patient requests or prefers it.
  • The patient's condition requires care you cannot provide.
  • You feel your emotional state may interfere with the provision of the care now required.

The reasons for a transfer of care should be discussed with the patient so they do not feel as if they have been abandoned.

Provide emotional support

Patients and families experience a range of emotions following an adverse event. Surprise at the occurrence of the adverse event may turn into mistrust, frustration, and anger.

It is important to meet the emotional needs of your patients. Let them know you will be there for them. The aim is to support healing and restore trust.

Document the adverse event

Document the facts in the progress notes:
  • the clinical situation as it now exists
  • the consent discussions, options, and decisions made by your patient or the family regarding any future clinical investigations, treatments, and consultations and the rationale for these
  • any care provided

Return to top


2. Plan the initial disclosure

What are the facts

Before meeting with the patient, the attending physician determines the facts as known at this stage, decides who will be present at the disclosure discussion, and establishes when and where the discussion will occur.

Who will be involved

Medical students and residents involved in an adverse event should report it to their supervising physicians. They should be encouraged to be present to observe the disclosure discussion as a learning experience.

When and where will the meeting occur

The healthcare team should also decide when and where the initial meeting will occur.

Depending on the nature of the event or the anticipated reaction of the patient, the attending physician may also consider having others present (with the patient's permission) such as:
  • family members (with the consent of the patient)
  • other healthcare providers directly involved with the care
  • skilled communicators, as necessary
  • a translator if required (preferably not a family member)
  • those required to meet any special needs of the patient (e.g. cultural, vision, hearing, spiritual needs)

The healthcare team should decide which team member would be most appropriate to lead the discussion. Whoever is chosen to lead should be in a position to provide the necessary information to the patient and be able to answer any clinical questions the patient may have.

Return to top


3. The initial disclosure meeting

Provide the known facts

There is no such thing as a perfect disclosure discussion. Despite planning for the discussion and anticipating the patient's needs, there is no script to follow.

Provide the known facts. Be careful not to jump to conclusions before all the facts are known.

Be sensitive

Be sensitive to how much information is being provided and what your patient is ready to hear.  

Patients should be allowed to absorb information at a rate they are comfortable with.

Remember to be genuine, sincere, and compassionate.

Do not speculate or blame

Self-serving, defensive statements accompanied by blame for others will only increase tensions and are not helpful.