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However, patients wanted an explanation, not to assign blame, but to understand what happened and to ensure that actions were being taking to prevent future events. In fact, earlier research reported that patients commonly filed malpractice suits as a result of insensitive handling and poor communication following medical error, because they wanted to ensure that similar errors were not repeated.

Ten years later after the publication of her study, Dr. Wendy Levinson says things have changed. Levinson points to numerous guidelines on medical error disclosure that have burgeoned all across the world. In fact, the guideline encourages health care providers to explicitly apologize for their errors. Hugh MacLeod, the Chief Executive Officer of the Canadian Patient Safety Institute, also acknowledges how critical medical error disclosure is to the prevention of future medical errors.

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The truth is no one really knows. Of the limited research on the topic, most is qualitative or survey-based. Where these systems exist, most rely on voluntary reporting of medical errors, which only captures a tiny fraction of medical error. Most importantly, these data cannot capture whether individual physicians actually disclosed errors to patients, or simply documented events anonymously to local reporting systems. Engaging health care practitioners in error disclosure is made more complicated by the current clinical environment where care is often delivered by multiple providers across multiple settings.

Because of this, when a medical error occurs, responsibility may not actually reside with one individual. However, existing guidelines on medical error disclosure fail to address this complex and increasingly common situation. These trends have health care leaders calling for more institutional support and responsibility for medical error disclosure. Recently, Dr.

Part of this support will need to focus on educating clinicians how to disclose medical errors in a patient-centric and respectful manner, especially when the error involves other clinicians. Levinson also notes that while the physician may ultimately disclose an error to a patient and their family, it really is a team effort, especially when multiple providers are involved in an error. Despite a heightened focus on patient safety and an explosion of guidelines on medical error disclosure, real change may require a cultural shift.

In a TED Talk that has received nearly one million views, Goldman implores physicians to talk about their mistakes.


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She shares her experience with others. And she works in a culture of medicine that acknowledges that human beings run the system, and when human beings run the system, they will make mistakes from time to time. Remember Me. Yes, add me to your mailing list. This is completely shocking to me. I knew this was a problem, but to what extent I had no idea.

New patient safety toolkit to help GPs avoid errors - The University of Nottingham

I hope that healthcare policy begins to catch up with this and start protecting patients and their families from these kinds of unnecessary errors. The first thing to do is reduce the errors. I fear evidence-based medicine will have only a minor impact on errors in the complex systems of care we operate. There is a need to inculcate a culture of mindfulness and vigilance against error, and systematically to eliminate avoidable causes of large volume error such as handwritten orders, transcription of orders and prescriptions, and picking and preparation of medication doses.

There is also an urgent need to avoid political spinning of safety data and to be careful about how numbers are presented. An error rate of 1 in therefore means that there were that in that year, there would be 1. This a vast scale of severe error. The first step in creating a culture of safety is to confront the data in an honest manner, even when it is daunting. My experience with hospitals that intentionally concealed harm caused to my elderly mother, and the experiences of so many other patients and families, attest to a deep-seated pathology that too often surfaces in Canadian hospitals when it comes to disclosing errors, much less preventing them.

The fact of the matter is that where there is no effective accountability to patients and families, which is largely the case in the hospital system, there is no incentive to disclose or to be truthful. It took a massive change in the law to force necessary changes in behaviour on the part of the decision-makers involved.

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Where would we be today if we had relied upon the altruism or good will of that sector to make society safer? We need laws that would make it a criminal offense for hospitals to deliberately fail to disclose harm to a patient or to cover it up. And make no mistake, this happens every day.

To those members of the healthcare professions who prefer a gentler approach as to how and when errors and harm should be disclosed, I say, with respect, that train long ago left the station. We are facing an epidemic of hospital harm in Canada, the United States and elsewhere. It is the third leading cause of death. Too many patients are being avoidably killed and injured and too many families are having their lives turned into a train wreck by unethical practices and deceit. Yet the knowledge about what to do to prevent this harm through better use of technology and best practices, for instance, is well documented.

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What does not exist is the necessary disincentive to withhold or cover-up vital information about the harm. For while some will continue to argue that errors will always occur by inadvertence, they cannot deny that the decision to withhold disclosing that harm or deciding to cover it up is always the result of a deliberate, intentional and highly premeditated act.

It is the one that patients and families always view as the ultimate betrayal. That is one reason Patient Protection Canada www.

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But to end this epidemic, we need to eradicate the hospital culture of delay, denial and deception that too often follows these events. It might very well be human error to hit someone with your car on a dark and rainy night. But if you just drive off and fail to report it, human nature will be no defense in the face of the tough criminal proceedings that will follow.

Too many patients and families have felt like the victims of a hit-and-run in their hospital experiences. Your commentary was excellent and to the point. This course [online] was outstanding and it teaches how everyone in the system is required to make health and safety a priority from the CEO to the cleaning staff, and well beyond…anyone who works in the hospital and the patients and the visitors all play a role.

The blame game is out.. And this course get you there. Mistakes happen because we are human and we err but it is a flawed system that enables a continuing problem.

The Michigan Model centers on saying sorry when clinical care does not go as planned. Especially in the context of the Canadian system, these dollars could presumably be re-invested into error prevention initiatives. Excellent commentary. As a victim of a medical error and continuous coverup by practically all doctors and as a legal consultant LL. Please be aware that the current sytematic coverup of medical errors to victims of medical errors and their relatives is a deliberate decision of individual doctors, time and time again.

Coverup also means: no followup diagnostics, no remedical medical care which causes additional unnecessary physical damage to the patient, which should have been avoided.

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Furthermore we found out that many lawyers collaborate behind the scenes with negligent doctors and pretend they defend victims of medical errrors. On top of that it has been proven that judges in high level courts in Europe even the European Court of Human Rights are corrupt, as they ignore facts and documents of medical negligence by individual failing doctors. Journalists dare not publish for fear of not receiving medical care…… Apparently the old boys networks is very strong.

Availability bias — thinking that a similar recent presentation you have encountered is also happening in the present situation. Confirmation bias — looking for evidence to support a pre-conceived opinion or notion, rather than looking for information to prove oneself wrong. Diagnosis momentum — accepting a previous diagnosis without applying sufficient scepticism.

Premature closure — similar to confirmation bias, but more like jumping to a conclusion. They may then fail to undertake a broader search for other possibilities. The case involves the failure to diagnose a week gestation pregnancy in a year-old presenting with symptoms of vomiting and amenorrhea. She denies having had sex and a pregnancy test is not carried out. The girl goes on to deliver a healthy baby but develops post natal depression. She raises a claim against her GP arguing that, had she known she was pregnant, she would have requested a termination.

An existing three-year history of sinusitis was assumed to be the cause of her present difficulties early in the encounter, and this was diagnosed as the cause of her nausea and vomiting. A period of three months then passed during which several consultations took place, before a home pregnancy test proved to be positive. Our expert made a number of observations about her care, including:. Within this thinking we can see characteristics of several identifiable thinking errors.

1. Upcoding

Our expert concluded that a patient who is seen by one or even two doctors potentially gains an advantage from better continuity of care. But a patient seen by a number of doctors about the same problem runs the risk that no particular practitioner will ultimately take responsibility for a full review of presenting symptoms. So, can we guard against this occurring?