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The truth be told
Honesty is now a matter of policy at the McGill University Health Centre.
The MUHC has become one of the first major Canadian healthcare institutions to formally adopt a patient disclosure policy across its hospital network: the Montreal Children's, Royal Victoria, Montreal General and Montreal Neurological Hospitals. The ultimate purpose of the disclosure policy is to inform patients when medical errors are made or when unplanned outcomes occur.
"Creating this policy is our way of maintaining a relationship of trust between caregivers and patients," says Claude Forget, chair of the MUHC board of directors committee on quality and a former provincial health minister.
Marilyn Kaplow, MUHC director of quality management, agrees. "The MUHC's disclosure policy will offer patients a sense of complete transparency," she says, noting there's a push for health centres to provide disclosure policies across North America. "The MUHC has created a disclosure policy not because it's popular, but because it's the right thing to do."
While MUHC administrators acknowledge that medical errors are inevitable and may even occur under conditions ordinarily associated with good results, the newly adopted disclosure policy obliges the MUHC to inform the patient, family or patient representative of any significant or unexpected incident that occurred during treatment. Those concerned must also be informed at the earliest possible moment and the "information should be presented in an empathetic fashion by someone who has the time and knowledge to answer the patient's questions."
Full disclosure is based on the patient's right to know as well as a desire at the MUHC to learn from such incidents and improve care. The MUHC will advise patients of a medical error even when the error has been corrected and the patient is no longer facing any harm as a result of the mistake.
"The MUHC has a moral and ethical duty to let patients know when an error has occurred," says Forget. "Failing to disclose errors undermines public trust in the health care system."
In the U.S., it is estimated that medical errors kill between 44,000 and 98,000 patients each year. No estimates are available for Canada, but a study is underway to determine the number of medical errors made in this country.
Patient and community groups were involved in the development of the MUHC's new disclosure policy. According to Kaplow, four patient representatives and six community members sit on the MUHC's committee on quality, which shaped the disclosure procedures. "Patient groups have been involved in creating this disclosure policy all along," she says.
The patient disclosure policy is building on similar guidelines previously adopted by two MUHC hospitals in the past: at the Royal Victoria in 1989 and the Montreal Children's in 1990. Now, Kaplow says, the challenge will be to educate and inform some 10,000 MUHC staffers on how to use the disclosure policy on a day-to-day basis.
That challenge could prove difficult among some health practitioners, says Forget. "Most professionals are wary of disclosing mistakes, since many believe it may damage a [malpractice] case."
A mistaken assumption, he continues, explaining that malpractice suits involving the Children's and Royal Victoria did not skyrocket after the hospitals implemented disclosure policies.
"These policies make people less defensive," he says. "If patients know all the facts, then they're less likely to go see a lawyer and reason, 'this is the only way to know the truth.'"
Professor Margaret Somerville, director of the McGill Centre for Medicine, Ethics and Law, applauds the move. She agrees that many physicians fear the notion of full disclosure needlessly.
"Things go wrong in medicine. Most physicians think an error means they will be seen as negligent. They get scared that they could be sued.
"A medical error does not necessarily mean there has been negligence if it's an error that any reasonably cautious physician could have made. If there is no disclosure, however, that could be negligent and you could face really serious legal liability as a result."
Somerville adds that patients usually suspect when things aren't right with the treatment they've received. "What the research shows is that most people intuit something's wrong even when they haven't been told.
"With the whole issue of informed consent, doctors used to say, 'If we tell the patients all the risks, they'll never say yes to treatment.' We see now that what happens with informed consent is that, when things do go wrong, patients are much less distressed and angry about it."
It will be the responsibility of all MUHC medical staff to flag potential errors to supervisors. In most cases, Forget says, the treating physician will then ensure facts are reported back to patients or their representatives.
All told, Kaplow and Forget stress, the creation of an MUHC disclosure policy will foster peace of mind. "People will have faith that when they go into surgery, if a mistake occurs, they'll know about it," says Kaplow.