Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical (...) community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions—such as guilt, regret and remorse—appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error. (shrink)

Von Mitarbeitenden im Gesundheitswesen wird ein professioneller Umgang mit PatientInnen und Zugehörigen verlangt. Die Begleitung in Lebenskrisen, bei Erkrankung, Sterben und Tod stellt hohe Anforderungen. Als besonders belastend kann erlebt werden, wenn Mitarbeitende bei der Entscheidungsfindung in Gewissenskonflikte geraten oder sich in einer Dilemmasituation wiederfinden. Das Spektrum reicht von außergewöhnlichen Triage-Entscheidungen bis hin zu einem – vergleichsweise häufigeren – Beteiligtsein an einem (mutmaßlichen oder Beinahe‑) Behandlungsfehler. Angesichts der teilweise tragischen Auswirkungen auf die Patienten und Zugehörigen, die ihr Vertrauen in die (...) Institution gesetzt haben, wird der Umgang für die Mitarbeitenden vor allem dann zusätzlich belastend, wenn innerhalb der Organisation kein glaubwürdiges Konzept für einen strukturierten Umgang mit derartigen Ereignissen etabliert und unter den Kolleginnen und Kollegen sowie Vorgesetzten wenig Wissen über hilfreiche Unterstützungsmöglichkeiten vorhanden ist. (shrink)

Von Mitarbeitenden im Gesundheitswesen wird ein professioneller Umgang mit PatientInnen und Zugehörigen verlangt. Die Begleitung in Lebenskrisen, bei Erkrankung, Sterben und Tod stellt hohe Anforderungen. Als besonders belastend kann erlebt werden, wenn Mitarbeitende bei der Entscheidungsfindung in Gewissenskonflikte geraten oder sich in einer Dilemmasituation wiederfinden. Das Spektrum reicht von außergewöhnlichen Triage-Entscheidungen bis hin zu einem – vergleichsweise häufigeren – Beteiligtsein an einem Behandlungsfehler. Angesichts der teilweise tragischen Auswirkungen auf die Patienten und Zugehörigen, die ihr Vertrauen in die Institution gesetzt haben, (...) wird der Umgang für die Mitarbeitenden vor allem dann zusätzlich belastend, wenn innerhalb der Organisation kein glaubwürdiges Konzept für einen strukturierten Umgang mit derartigen Ereignissen etabliert und unter den Kolleginnen und Kollegen sowie Vorgesetzten wenig Wissen über hilfreiche Unterstützungsmöglichkeiten vorhanden ist. (shrink)

BackgroundExperience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea.MethodsWe applied the COREQ checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth interviews and focus group (...) discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines.ResultsOpen disclosure perceptions were summarized in terms of the “five Ws and one H”. All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure.ConclusionPhysicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure. (shrink)

Disclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known.

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (shrink)