Health Affairs, 22, no. 3 (2003): 248 doi: 10.1377/hlthaff.22.3.248 © 2003 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Letters

Hospitals Disclosing Harm

Although many hospitals fear litigation, not disclosing unanticipated harm may be a more important contributor to patient dissatisfaction and resulting litigation. Gerald Hickson and colleagues report that lack of communication about serious events has been interpreted by some patients and families as hiding information or attempting a cover-up.¹ Will disclosure decrease the number of claims and lawsuits? It is too soon to determine. What we do know is that disclosure can reduce feelings of abandonment, acknowledge suffering and grief, keep the patient informed, and assist with the defense of a claim. But having a disclosure policy is not enough. Robert Buckman describes the difficulties faced by clinicians due to lack of training in sharing bad news as well as dealing with the reactions of patients.² Working with staff to deal with these difficult situations, such as using role playing, is necessary. Equally important is providing emotional and psychological support not only for the patient, but also for the clinicians involved.

Frank Federico

Risk Management Foundation, Cambridge, Massachusetts

NOTES

1. G.B. Hickson et al., "Factors That Prompted Families to File Medical Malpractice Claims following Perinatal Injuries," Journal of the American Medical Association 267, no. 10 (1992): 1359–1363.[Abstract]
2. R. Buckman, How to Break Bad News, A Guide for Health Care Professionals (Baltimore: Johns Hopkins University Press, 1992).

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