Surgeons reluctant to discuss adverse events with patients

Only about 1 in 3 surgeons respond to adverse events by discussing how to prevent the problem from reoccurring, according to a study published in JAMA Surgery.

Researchers, led by A. Rani Elwy, Ph.D., of the Veterans Affairs Boston Healthcare System and the Boston University School of Public Health, analyzed surgeons’ reports of error disclosures and surveys of their experiences, polling 35 surgeons across multiple specialties. They found that most respondents used five of the eight recommended disclosure procedures:

  • An explanation of why the error occurred (92 percent of respondents)
  • Expression of regret for the event (87 percent)
  • Expression of concern for the patient (95 percent)
  • Disclosure within 24 hours of the adverse event (97 percent)
  • Discussing steps they took to address any future problems (98 percent)

However, they found the remaining three recommended procedures were less common: only 55 percent apologized to patients or discussed whether anything could have been done to prevent the error, whereas only 32 percent discussed how to prevent recurrences.

Of the 45 percent of surgeons less likely to have discussed prevention with patients, two thirds said the event in question was very to extremely serious, and 26 percent said they had difficulty discussing it. Both these groups more likely to report that the event negatively affected them. Anxiety about outcomes ran higher among surgeons with negative attitudes about disclosure, according to Rani and her team.

“Surgeons who reported they were less likely to discuss preventability of the adverse event, or who reported difficult communication experiences, were more negatively affected by disclosure than others,” researchers wrote. “Quality improvement efforts focused on recognizing the association between disclosure and surgeons’ well-being may help sustain open disclosure policies.”

Adverse events are a major problem within the healthcare industry, and 20 percent of hospitals nationwide have no concrete policy for such events, FierceHealthcare previously reported. Patient safety experts are concerned lawsuit-wary hospitals maintain a “culture of secrecy” that keeps patients themselves out of the loop.

- read the study abstract