What should doctors disclose to patients in the aftermath of adverse events?  Does it matter if the adverse event was related to an error?  Does it matter if it was preventable or not, anticipated or unexpected?

Recently, I was at the Carolina Refresher Course facilitating a session on adverse events in anesthesiology.   We touched on a variety of issues, but spent the most time discussing the importance of disclosure conversations, as well as the challenges that we face.

What is disclosure?

Disclosure is really a process rather than an event, and is the series of conversations that convey information to the patient about an adverse outcome, and sometimes, a medical error (if one has occurred).   Like many realms of professionalism, this is rarely given adequate attention in medical school or residency training, and as such, many doctors express uncertainty about what to say, how to say it, and sometimes, whether anything should be said at all.

An “adverse event” includes any untoward outcome, regardless of whether an error occurred.  “Error” implies that a deviation from standard of care or best practice occurred, whether by an incorrect action (doing the wrong thing) or an omission (failure to do the right thing).

What are potential barriers? 

Anesthesiologists face some unique, specialty-specific barriers, in addition to barriers that are present across the board in all medical circumstances.

Continue reading...