It’s one of the scariest moments that a pediatrician will face in his or her career: a medical error or preventable adverse event. The interactive group forum, “Dos and don'ts of disclosing preventable adverse events and medical errors” presented by Karen Santucci, MD, FAAP, Professor of Pediatrics, Section Chief of Pediatric Emergency Medicine at Yale School of Medicine in New Haven, Connecticut, and Laura Sigman, MD, JD, FAAP, Director of Legal and Policy Coordination at Children’s National Hospital in Washington, DC, offered practical advice on how to face an event that could be career-defining.
Gone are the days of legal departments at hospitals telling doctors to deny everything and not speak to the patient or the patient’s family about the adverse event. Today, the pediatric provider should remember the “A, B, C, Ds”: apology, backup, communication, disclosure, and support.
Dr Sigman said that in the past an apology was seen as the so-called uppercase version, meaning an admission of guilt and taking responsibility for the incident, rather than the lowercase expression of sympathy or regret over the situation. Thirty-nine states provide protection for expressions of sympathy and a handful of states even provide further protection for admissions of guilt.
Backup means involving other providers who can provide assistance, such as charge nurses, social workers, and practice managers.
Communication involves speaking empathetically and as often as needed to the affected parties. It can also involve explaining how the error will be prevented in the future.
Disclosure is another element where disclosure can mean something different to the provider and the legal team. For the provider, it can involve telling the patient when an error has occurred, but for the legal team it involves far more and can have implications in any resulting legal action. Support can help mitigate the likelihood of the provider from being a “second victim” of the adverse event. Providers should seek out support from spouses, therapists, and other groups who are protected from being involved in legal action.
Dr Sigman also stressed that providers should remember that taking five minutes in the immediate aftermath of an adverse event can save many hours of frustration later in the process. She also urged providers looking for more resources to use the Josie King Foundation, which was created after the death of girl aged 18 months from a medical error, or the Communication and Optimal Resolution toolkit from the Agency for Healthcare Research and Quality.