Avoid the risk: be open when you make a mistake

The Medical Council spoke to Dr Rosa Canalese, senior medical adviser at Avant and a Central Coast GP about communication strategies with patients when there’s been a mistake in clinical practice.

Interview:

MC: How should you communicate to a patient when they have made a mistake?

The first consideration for a doctor in the event of a mistake, is safety of the patient.  If there is an immediate risk of harm (such as a significant prescribing error), the practitioner should act straight away to make contact with the patient.  Most of the time, there is no immediate risk of harm.

If there is no immediate risk, it is important to take stock of what happened and how you are feeling. All doctors make mistakes, but facing the realisation that you are the doctor that has made the mistake can be confronting and a cause for significant distress for doctors.

MC:  How do you approach disclosure when you make a mistake?

You should make an open disclosure to the patient. This may be a difficult conversation, as you do not know how the patient will react.  This is a difficult conversation as you are opening up yourself to criticism, and you may be exposed to anger and tears.  Doctors should practice the discussion with professional colleagues. While open disclosure is encouraged, a patient may still complain to the Council or take further action against the doctor.

Where this happens the doctor’s openness with the patient helps to reassure the Council of the doctor’s commitment to good professional standards.

MC: How do you manage that difficult conversation with a patient?

I generally advise that the doctor should take in a support person, but you don’t want to outnumber the patient if they are approaching the conversation on their own. I often speak to the doctor about how the meeting may go.

The doctor needs to be prepared. A lot of it is skillful communication and being perceptive. I advise doctors to plan for the meeting, to get the patient’s concerns in writing before the meeting, prepare how they will respond to these concerns and to set ‘ground rules’ regarding how the meeting will progress.

MC: What if there’s no risk of harm to the patient?

While it is tempting not to tell patients about every mistake, even a low level mistake with minimal risk of harm needs to be communicated with the patient. This could be when you have given them the wrong prescription, or when a child gets the wrong vaccination. For example, the child may be due for a six month vaccination and they receive the 12 month jab. There is not a lot of harm in this, but you have to let the parent know that the child hasn’t got the correct vaccination. Any mistake that requires an action, needs to be communicated with the patient.

MC: Does saying sorry mean a doctor is more likely to be get sued?

Saying sorry and advising the patient how you have changed your practice reduces the risk that the mistake will happen again and may prevent a complaint being lodged against you. There is no evidence that you are more likely to be sued because you said sorry. Being insightful and making admissions when appropriate is helpful.

MC: When can open disclosure be difficult?

If you don’t work in a culture that supports open disclosure it can be difficult. Some medical practices and hospitals may not be supportive of that culture.

Junior doctors may be concerned that admitting a mistake will be harmful to their career and reputation. . If a doctor is treated badly because they have admitted a mistake, they are not going to be open. It is important that doctors feel supported in being open about their mistakes.

Further resources:

NSW Medical Councill: what it means to say sorry

https://www.mcnsw.org.au/what-it-means-say-sorry

Australian Commission on Safety and Quality in healthcare: open disclosure 

https://www.safetyandquality.gov.au/our-work/clinical-governance/open-disclosure

Avant: Open disclosure: how to say sorry

https://www.avant.org.au/Resources/Public/20140506-open-disclosure/

NSW Ombudsman: the power of sorry

https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0018/6246/SP_PowerSorry_JudicialCommissionNSW-16Feb11.pdf

"The first consideration for a doctor in the event of a mistake, is safety of the patient"