Disclosure

Support Materials

Slide Presentation

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References

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  1. AMA’s Council on Ethical and Judicial Affairs, “E-8.12 Patient Information”, Code of Medical Ethics: Current Ethical Opinions, Chicago: American Medical Association, June 1994, one page. (www.ama-assn.org/ama/pub/category/8497.html)
  2. Popp P. Disclosing medical errors: how will it effect future litigation? Risk Management Foundation Forum. 2003;23:8-9.
  3. Hebert PC. Disclosure of adverse events and errors in healthcare: an ethical perspective. Drug Safety. 2001;24(15):1095-1104.
  4. Kraman SS and Hamm G. Risk management: extreme honesty may be the best policy. Annals of Internal Medicine. 1999;(12):963-67.
  5. Wu AW, et al. To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. Journal of General Internal Medicine. 1997;(12):770-75.
  6. Morath J and Hart T. Partnering with families: disclosure and trust. In: Patient Safety Initiative 2000; Spotlight on Solutions; Compendium of Successful Practices, Volume One. Chicago: National Patient Safety Foundation. 2001:247-51.
  7. Perspective on Disclosure of Unanticipated Outcome Information. Chicago, IL: American Society for Healthcare Risk Management. 2001:20.
  8. Lamb RM, et al. Hospital disclosure practices: results of a national study. Health Affairs. 2003;22(2):73-83.
  9. Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press, 1992
  10. Ptacek JT and Eberhardt TL. Breaking bad news: a review of the literature. Journal of the American Medical Association. 1996;276:496-502
  11. Wu, AW. Medical error; the second victim. British Medical Journal. 2000;320:726-27.
  12. Crane M. What to say if you made a mistake. Medical Economics.2001;78 (16):26-28,33-36.
  13. Talking to Patients About Health Care Injury: Statement of Principle. Chicago, IL: National Patient Safety Foundation, November 14, 2000.

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Facilitator's Guide and Outline

A full outline of the key messages for this module, including links to slides, references, and facilitation tips.

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Video

First, Do No Harm

CRICO insured who would like information about borrowing a copy of the video, please contact us via our Patient Safety Products form

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Facilitation Tips

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  1. Practical Application

    For audiences already knowledgeable about the basic principles of patient disclosure, the 17-minute video, First, Do No Harm, offers an excellent opportunity for practical application by exploring multiple perspectives of an adverse event that should be disclosed to the patient’s husband. Following is a suggested outline for using the video.

    1. Assign participants roles representing the major players in the case, and ask them to view the video from that perspective:
      Patient/family;
      Physicians, nurses;
      Hospital administrators.
    2. Introduce First, Do No Harm (information about the case is available in the facilitator’s guide).
    3. Break into small groups (either of the same perspective or mixed perspectives) in order to discuss the disclosure process, based on these questions.
      Physicians: What will you say to Mr. Romanov?
      Patient/family: What do you want to hear from the clinicians?
      Nurses: What is your role in the disclosure process?
      Administrators: What type of disclosure policy and support is in place?
    4. Through questions and answers and discussion, attempt to address the following points:
      • Getting started
      • Developing a pro-active stance in communicating error
      • Developing appropriate, patient-focused processes for disclosure of error
      • Increasing one’s range of communication techniques for disclosing error

  2. Role Playing

    Role-playing is an excellent tool for instructing clinicians in conducting a patient disclosure discussion. Because of the sensitive nature of this topic area, we recommend the use of instructors trained and experienced in guiding role-play sessions. (Contact Program Director, Loss Prevention & Patient Safety Operations, Ann Louise Puopolo, BSN, RN for recommendations regarding experienced role-play trainers).

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Exercise

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Resident's Module: Teaching Notes

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