Saying sorry for medical mistakes

SERIOUS failures on the part of healthcare providers can result in devastating outcomes for patients and their families, as well as having traumatic effects on healthcare staff.

Ireland is not unique in this, as errors occur in every healthcare system in the world. The international evidence is that one-in-10 patients admitted to hospital suffer from adverse events such as medication-related errors, surgical errors, healthcare-associated infections, medical device failures, errors in diagnosis, and failure to follow up on test results.

Why do these errors happen? Healthcare professionals are taught that errors are unacceptable: No diagnosis, allergy or previous medical problem can be missed; every test must be tracked down; every medication dose must be exactly right.

But healthcare is not risk-free — it is often very complex, with use of new technologies and medicines, older and sicker patients who often present with a number of different disorders, and increasing economic pressure on health systems which can lead to overloaded healthcare environments and overworked staff.

Some errors are due to poor design of the system of delivery of care; others are caused by caring, competent and hardworking people who make a simple mistake.

When mistakes are made, patients are entitled to know. Saying sorry is not enough — patients want an explanation of what went wrong and why. Studies show that many patients are motivated to take legal action because they are angry and frustrated by incomplete or delayed information about what happened to them.

Nine out of 10 patients who have been harmed sue because they want an explanation and, most importantly, they want an assurance that lessons have been learned in order to prevent a recurrence. Almost half of patients who sue do so because of the attitude of hospital staff following the error. And of course, patients who have been harmed often need financial compensation to facilitate their rehabilitation or other care needs into the future.

There have been a number of medical negligence cases before the High Court in the recent past in which Ms Justice Mary Irvine has criticised the HSE for inordinate delay in acknowledging liability and apologising to patients who have been harmed by medical errors. So why is it that hospitals and healthcare professionals who seek to provide safe, quality care to patients tend to default into a culture of silence and defensiveness rather than honesty and compassion when something goes wrong?

A Medical Council survey in 2011 showed that 88% of Irish patients trust their doctors to tell them the truth and there are many committed and dedicated doctors and other healthcare professionals who want to do the right thing by being open and honest with their patients, but may feel inhibited by lack of support in their organisation, or fears of litigation or loss of reputation.

The Commission on Patient Safety stated in its report in 2008 that the current system of compensation for medical negligence in Ireland is not conducive to an open and honest communication process. Clinicians and risk managers are fearful of the consequences if they inform patients of an adverse event, with the result that often the event remains undisclosed and therefore the lessons from the event are never learned or shared with others who may be in similar situations in the future.

The commission recommended that if something happens to a patient in the course of treatment, which impacts on the person’s health or quality of life, the patient should be informed of this event, given an adequate explanation of the event and reassured that measures have been taken to prevent such an event occurring again in the future.

Since the commission’s report in 2008 a number of healthcare agencies such as the Health Information and Quality Authority, the Medical Council, and the Nursing Board have stated their support for open and honest communication with patients following an adverse event. The HSE, in collaboration with the State Claims Agency, published a new national policy on open disclosure last November and they also provide training courses for healthcare professionals on the policy.

So what difference will these new policies make? If successfully implemented, experience in other countries in which open policies already exist show us that the rate of litigation decreases dramatically as patients feel they have been treated with honesty and respect; the length of time to process compensation cases reduces as there is less in dispute; and there are consequently less legal costs, with resultant savings which can be instead invested into patient safety initiatives.

But the reason for adopting open disclosure policies is not to reduce litigation, although this may be a desirable side effect. Rather, the point is to encourage health systems that value integrity and professionalism so that errors can be reduced and injured patients can be properly cared for. This requires a change in culture in healthcare, both at clinical and managerial level. The progress that has been made in this area since the commission’s report must continue to build a culture of patient safety so that patients who have been harmed will receive the open, honest, compassionate, high quality care that they deserve.

* Deirdre Madden is a senior lecturer in law at UCC and chairwoman of the Commission on Patient Safety.


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