Disclosure After Complication in the OR

2013 ◽  
Author(s):  
Mark J Meyer ◽  
Norbert J Weidner
Keyword(s):  
Therapeutic Relationship ◽  
Medical Error ◽  
Adverse Outcomes ◽  
Psychological Support ◽  
Sincere Apology ◽  
Medical Mistakes

In matters of medical error and complications, patients and families overwhelmingly want to be informed. Most patients want providers to disclose if a complication or an error has occurred, and want to be informed of any possible adverse outcomes from the event. Most want to be informed immediately following an event and expect an investigation when the cause is not readily identified. When the event is due to an error, patients and families want honest disclosure and a sincere apology from those responsible. Afterward, they want continued emotional and psychological support, and they expect efforts to identify and correct the cause. Historically, physicians and institutions have been slow to fully disclose errors, especially if they were preventable. Patients have frequently not been provided with the support they require and often have felt frightened and alienated. The immediate effects of medical mistakes can be devastating, but the subsequent emotional, personal, and relational consequences can be very distressing. Silence, shame, guilt, and fractured trust disrupt the therapeutic relationship and leave patients, families, and caregivers to suffer alone.

Incidence of medical error and adverse outcomes on a pediatric general surgery service

2003 ◽  
Vol 38 (9) ◽  
pp. 1361-1365 ◽  
Author(s):  
Monja L Proctor ◽  
Jennifer Pastore ◽  
Justin T Gerstle ◽  
Jacob C Langer
Keyword(s):  
General Surgery ◽  
Medical Error ◽  
Adverse Outcomes

Disclosure after Complication in the Operating Room

2018 ◽  
Author(s):  
David A. Young
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Medical Errors ◽  
Medical Error ◽  
Legal Liability ◽  
Appropriate Use ◽  
Near Misses ◽  
Sentinel Events ◽  
Poor Outcomes ◽  
Sincere Apology

Patients and families overwhelmingly want to be informed regarding matters related to poor outcomes and medical errors. After the occurrence of a medical error, most patients and families highly value an honest and transparent disclosure of the details as well as a sincere apology from the parties responsible regardless of the degree of apparent harm. When disclosing a medical error to a parent or patient, an organized approach using a truthful and compassionate discussion as the backbone is the most prudent strategy. Additionally, effective disclosure practices can decrease legal liability. This chapter discusses the differences between medical errors and poor clinical outcomes, the distinctions between near misses and sentinel events, the indications for disclosure of medical errors without apparent harm as well as the appropriate use of apology, and an approach for the effective disclosure of a pediatric medical error to a parent.

The emotional impact of medical error on Portuguese medical residents - An exploratory study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Mota ◽  
A Moreira de Sousa ◽  
L Ribeiro
Keyword(s):  
Health Professional ◽  
Medical Error ◽  
Exploratory Study ◽  
Unmet Need ◽  
Psychological Support ◽  
Medical Residents ◽  
Emotional Impact ◽  
Multiple Choice Questions ◽  
Cross Sectional ◽  
The Impact

Abstract Background The consequences of the medical error on patients are unquestionable. However, the emotional impact on the health professional that made the error is usually devastating and usually neglected. The present study aimed to study the perception and experiences in a sample of medical residents regarding the emotional impact of the medical error in a clinician. Methods A cross-sectional and exploratory study analyzed a sample of 264 Portuguese residents. A survey with multiple-choice questions was created, taking into account the available scientific literature on this topic. The survey was then shared online within the mailing lists and social groups of Portuguese medical residents. The responses were collected between 14th-29th February 2020. Descriptive and logistic regression analyses were carried out using R 3.6.1 and Rstudio 1.2.5033. Results 48,1% of the residents mentioned that at a certain point in their careers, they made a medical error. 98,4% of them had indirect contact (e.g., discussions with colleagues) with scenarios where a medical error could or was made. The residents that made a medical error had mainly feelings of guilt (85,8%), anxiety (73,2%), and frustration (64.6%). 93,7% of the clinicians that made a medical error reported more caution and the implementation of preventive measures in their future practice. 16,5% of them thought about leaving the medical profession. The odds for a medical error are 2,44 higher (95% CI 1,49-4,02) in the later phase of medical residency. Conclusions Although international literature describes the impact of medical error on the clinician, there is no published research on this theme in Portugal. The results allowed us to explore the emotional impact of these events and underline the unmet need for psychological support for the health professional. This exploratory study may serve as support for other research studies on this matter with a more robust methodology and a bigger sample size. Key messages Medical error is frequent and has an emotional impact on medical residents. Need for further research in Portugal and the creation of programs for psychological support.

Spotlight on the Clinician in the Life Participation Approach to Aphasia: Balancing Relationship-Centered Care and Professionalism

2020 ◽  
Vol 5 (2) ◽  
pp. 414-424
Author(s):  
Rochelle Cohen-Schneider ◽  
Melodie T. Chan ◽  
Denise M. McCall ◽  
Allison M. Tedesco ◽  
Ann P. Abramson
Keyword(s):  
Social Workers ◽  
Therapeutic Relationship ◽  
Interprofessional Collaboration ◽  
Opportunity To Learn ◽  
Subjective Experiences ◽  
Speech Language Pathologists ◽  
Self Disclosure ◽  
Centered Care ◽  
High Standards ◽  
Therapeutic Encounter

Background Speech-language pathologists make clinical decisions informed by evidence-based theory and “beliefs, values and emotional experiences” ( Hinckley, 2005 , p. 265). These subjective processes, while not extensively studied, underlie the workings of the therapeutic relationship and contribute to treatment outcomes. While speech-language pathologists do not routinely pay attention to subjective experiences of the therapeutic encounter, social workers do. Thus, the field of social work makes an invaluable contribution to the knowledge and skills of speech-language pathologists. Purpose This clinical focus article focuses on the clinician's contribution to the therapeutic relationship by surfacing elements of the underlying subjective processes. Method Vignettes were gathered from clinicians in two community aphasia programs informed by the principles of the Life Participation Approach to Aphasia. Results and Discussion By reflecting on and sharing aspects of clinical encounters, clinicians reveal subjective processing occurring beneath the surface. The vignettes shed light on the following clinical behaviors: listening to the client's “whole self,” having considerations around self-disclosure, dealing with biases, recognizing and surfacing clients' identities, and fostering hope. Speech-language pathologists are given little instruction on the importance of the therapeutic relationship, how to conceptualize this relationship, and how to balance this relationship with professionalism. Interprofessional collaboration with social workers provides a rich opportunity to learn ways to form and utilize the benefits of a strong therapeutic relationship while maintaining high standards of ethical behavior. Conclusion This clinical focus article provides speech-language pathologists with the “nuts and bolts” for considering elements of the therapeutic relationship. This is an area that is gaining traction in the field of speech-language pathology and warrants further investigation.

Employing Latino Value Orientations to Facilitate Success in Stuttering Treatment

2008 ◽  
Vol 18 (3) ◽  
pp. 111-118
Author(s):  
Lourdes Ramos-Heinrichs ◽  
Lynn Hansberry Mayo ◽  
Sandra Garzon
Keyword(s):  
Foreign Language ◽  
Therapeutic Relationship ◽  
Service Provider ◽  
Speech Therapy ◽  
Cross Cultural ◽  
Value Orientations ◽  
Collaborative Partnership ◽  
The Family ◽  
Therapy Services ◽  
Cultural Connections

Abstract Providing adequate speech therapy services to Latinos who stutter can present challenges that are not obvious to the practicing clinician. This article addresses cultural, religious, and foreign language concerns to the therapeutic relationship between the Latino client and the clinician. Suggestions are made for building cross-cultural connections with clients and incorporating the family into a collaborative partnership with the service provider.

Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle
Keyword(s):  
Treatment Effectiveness ◽  
Code Of Ethics ◽  
Oropharyngeal Dysphagia ◽  
Clinical Importance ◽  
Professional Services ◽  
Adverse Outcomes ◽  
Professional Judgment ◽  
Evidence Based ◽  
Intervention Selection ◽  
Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

Expressed Emotion in the Client-Professional Dyad

2004 ◽  
Vol 20 (4) ◽  
pp. 237-246 ◽  
Author(s):  
G. Van Humbeeck ◽  
Ch. Van Audenhove ◽  
G. Storms ◽  
M. De Hert ◽  
G. Pieters ◽  
...  
Keyword(s):  
Therapeutic Relationship ◽  
Correlation Matrix ◽  
Concurrent Validity ◽  
Positive Relationship ◽  
Expressed Emotion ◽  
Family Interview ◽  
Insufficient Time ◽  
Perceived Criticism

Summary: Background: This article reports on a study of the concurrent validity between the standard expressed emotion instrument, the Camberwell Family Interview (CFI), and two alternative EE measures, the Level of Expressed Emotion (LEE) and the Perceived Criticism Scale (PCS). Methods: The research sample consisted of 56 schizophrenic clients, who were residing in sheltered residences, and 56 professionals. Results: Based on the results of the correlation matrix between all the subscales of the instruments, a significantly positive relationship was found between the criticism scale of the CFI, the total score of the LEE, and the client version of the PCS. These correlations, however, were rather weak, which implies that the three instruments have little in common with each other. The professionals' version of the PCS does not appear to be an EE instrument. Conclusions: The results suggest that the CFI still remains the best instrument for assessing EE in a therapeutic relationship (between a professional and a client). If there is insufficient time to administer the CFI, then the client version of the PCS and the LEE can be used with the qualification that the PCS and LEE also measure other aspects and thus cannot completely replace the CFI. Nevertheless, the research indicates that asking the clients would seem to provide a better indication of the level of the professionals' criticism rather than asking the professionals themselves directly.

Psychometric Properties of the German Version of the Scale to Assess the Therapeutic Relationship in Community Mental Health Care (D-STAR)

2012 ◽  
Vol 28 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Sabine Loos ◽  
Reinhold Kilian ◽  
Thomas Becker ◽  
Birgit Janssen ◽  
Harald Freyberger ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Psychometric Properties ◽  
Therapeutic Relationship ◽  
Internal Consistency ◽  
Convergent Validity ◽  
Community Mental Health Care ◽  
German Version

Objective: There are presently no instruments available in German language to assess the therapeutic relationship in psychiatric care. This study validates the German version of the Scale to Assess the Therapeutic Relationship in Community Mental Health Care (D-STAR). Method: 460 persons with severe mental illness and 154 clinicians who had participated in a multicenter RCT testing a discharge planning intervention completed the D-STAR. Psychometric properties were established via item analysis, analyses of missing values, internal consistency, and confirmatory factor analysis. Furthermore, convergent validity was scrutinized via calculating correlations of the D-STAR scales with two measures of treatment satisfaction. Results: As in the original English version, fit indices of a 3-factor model of the therapeutic relationship were only moderate. However, the feasibility and internal consistency of the D-STAR was good, and correlations with other measures suggested reasonable convergent validity. Conclusions: The psychometric properties of the D-STAR are acceptable. Its use can be recommended in German-speaking countries to assess the therapeutic relationship in both routine care and research.

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