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Disclosure often needs more than one talk
Question: We've been making a lot of progress in changing our culture regarding the disclosure of adverse events, but we're still getting some resistance from physicians and staff about talking with the patient or family more than once. I think we sometimes need to talk to the patient or family once to give them an overview and let the information sink in, then come back later to discuss their questions. But some resist that idea, saying they want to disclose the facts all at once and be done with it. Which way is right?
Answer: For all but the most trivial disclosures, more than one conversation is usually required, says Thomas H. Gallagher, MD, assistant professor of medicine at the University of Washington School of Medicine in Seattle.
He says your problem is not uncommon. It has taken years for risk managers and physicians to accept the idea of full disclosure, and there has been great progress. But Gallagher says physicians and risk managers still harbor some misgivings about telling patients everything, without waiting for the patient to ask. Physicians, in particular, are not unanimous in their support of full disclosure or consistent in how they practice it. There is a growing concern among some physicians that there is now too much focus on the patient, he says, with no consideration of how disclosure can affect the health care provider.
That concern may be one reason they favor talking to the patient once and considering the task done. Discussing an adverse event with the patient or family can be extremely stressful for the physician or staff involved, and they may not want to go through it more than once even if they are philosophically in favor of full disclosure.
But to truly provide full disclosure, more than one talk is usually required, Gallagher says.
The initial conversation often happens shortly after the event, when relatively minimal information is available about what happened, why it happened, and how recurrences will be prevented. Follow-up conversations allow health care workers to provide patients with this important information as it becomes available.
Follow-up conversations also are important in that they allow health care workers to respond to questions that have arisen for patients since the initial conversation. Perhaps most importantly, he notes, these follow-up conversations help maintain the relationship with the patient and re-enforce the commitment of the institution and health care workers to transparency.
"I also have found that health care workers resist having more than one conversation, in part because these discussions are difficult and also because health care workers don't want to remind patients of the adverse event if the patient has already 'gotten over it,'" he explains. "By sharing with health care workers the rationale for these follow-up conversations as well as suggestions for how to help these discussions go more smoothly, I anticipate that multiple disclosure conversations following serious events will become the norm rather than the exception."
Source
For more information, contact:
- Thomas H. Gallagher, MD, Assistant Professor, Department of Medicine, Box 356178, University of Washington School of Medicine, Seattle, WA 98195. Telephone: (206) 543-4802. E-mail: [email protected].
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