When Things Go Wrong for Patients and Providers- A Mnemonic
In bygone days medical folk evoked “Therapeutic Privilege” to shelter vulnerable patients from the distress of discussing adverse outcomes caused by unintentional human shortcomings, inherent limitations of treatments and systematic errors. This silence also served to cover the buttocks of those privileged to hold all the information. Theirs was lonely sojourn in disillusionment and isolation.
Now the communication of difficult truths is upheld by codes of human rights, an autonomy based ethos and the legally sanctioned values of responsibility, accountability and transparency. This is a new era of hosting difficult conversations TOGETHER and accepting retributive justice, (why insurance is required of most practitioners for the benefit of the injured).
What follows in this mnemonic is guidance for addressing adverse outcomes. Underscored are the absolute non-abandonment of patients, diligence in preventing recurrences with self care, self improvement and camaraderie for providers.
TIPS-4 COMMUNICATING Adverse Outcomes/Errors
T – Find out the extent of their understanding first. TELL the TRUTH as it unfolds.
I – INVESTIGATE the sources; systemic and individual
P – PREVENT recurrences; register events (anonymously). Insuring it doesn’t happen to anyone else is a crucial issue for patients trying to find meaning living with an unexpected outcome.
S-4 SIT & STAY, allow SILENCE, say you’re SORRY, SEEK…
SEEK legal advice from your institution (Risk management), Professional College and malpractice insurance. Apologies, expressions of sympathy and regret are generally NOT considered admissible in court as legal evidence of fault or liability. Apology Act, SBC Canada 2006.
Patients will often forgive you for being fallible but they will NOT tolerate your lying, being uncaring or abandoning them. They often sue primarily to get the truth. Practice kindness and understanding towards yourself/colleagues
“Compassion which begins at home body and soul”-Meister Eckhart.