It has been recognised that domestic violence is a major health problem
in western societies, including Australia, and bodies such as the Australian
Medical Association (1989) and the Public Health Association of Australia
(1990) have called for the development and evaluation of protocols to
increase identification and enhance the management of domestic violence
victims. Indeed, one of the recommendations of the National Committee on
Violence in Australia (1990) was that medical education, whether
undergraduate, postgraduate or continuing, should include components
dealing with all aspects of violence. Studies have shown that victims of
domestic violence consult doctors more often than they consult police,
social workers or any other group of helping professionals (Dobash &
Dobash 1979; Dobash et al. 1985).
Disclosure of medical error in Australia
Adverse events happen Routine disclosure of adverse events is inevitable
Implementing disclosure is difficult – a mediation model may be the way
forward
Adverse events happen
Medical treatment is inherently risky
Adverse event: “an incident in which unintended harm resulted to a person
receiving health care.” (ACSQHC Open Disclosure Standard, 2003)
Occur in approx 10.6% of admissions (QAHCS 1995) – comparable with
overseas findings
Harvard study (USA): 18,000 people die every day partly as result of
iatrogenic injury (harm during health care)
Equivalent to 3 jumbo jets crashing every 2/3 days
50-80% of errors may be preventable
Not all errors involve negligence
Errors mostly due to system error
Routine disclosure of adverse events is inevitable Ethical obligations
Legal duties
Open Disclosure Standard
Open Disclosure Standard Open disclosure: open communication when things go wrong in health care
Elements:
Apology/expression of regret
Factual explanation of what happened
Explanation of potential consequences
Explanation of what is being done to manage the event and prevent its
recurrence
Implementing disclosure is difficult
Legal barriers: adequacy of legislative protection for apologies, fear of
increased litigation
Physician barriers: guilt, embarrassment, fear of reaction from peers, fear of
punitive sanctions, communication difficulties
Open disclosureOpen Disclosure involves clinicians in signalling to the patient and/or the
patient’s family that an adverse event has occurred.
“openness and honesty can help prevent events form becoming formal complaints and litigation claims” because “[b]eing open when things go wrong is clearly
fundamental to the partnership between patients and those who provide
their care” (National Patient Safety Agency, 2005). Open Disclosure policy
frames these moral-ethical principles within a legal liability discourse
however that sets limits on precisely how disclosure and its attendant
apology are articulated and enacted in situ.
How staff enact the openness that is advocated in Open Disclosure policy
is thus contingent on the degree of legal protection given to disclosures and
apologies. The challenge here is that staff needs to come to terms with the
uneven and often shifting legal landscapes that impact on them and their
work. In Australia, for example, partial apologies (‘We are sorry this
happened’) are nationally advocated, even though apology legislation in
New South Wales and the Australian Capital Territory (ACT) is such as to
prevent full apologies (‘We are sorry we made a mistake’) from being
admissible in court. Another challenge that lies at the heart of Open
Disclosure is the requirement that clinicians disclose adverse event
information to people who are physically injured and likely to be
psychologically affected by those adverse events.
Waiver of confidentiality with regards to disclosure to the police when it comes to trauma ( stab wounds)A substantial risk of serious avoidable harm to third persons will nearly always justify a breach of secrecy.There are provisions in various state and territory acts which will indemnify doctors against patients taking civil actions for certain disclosures. where summary offences are concerned, the attending doctor is under no duty to disclose information to the police. a somewhat diferent problem may arise when doctors are made aware from a patient that a serious criminal offence has been commited.
Patient may disclose that their condition has arisen as a result of the latter, or police may seek information from the doctor concerning a patient whose condition they believe may have resulted from a criminal attack. If the consent of the patient to diclose such information is not obtainable, doctors other than in queensland, must use their own judgement as to what course to take.Extra- in queensland, there is an obligation of the attending doctor in situation as :
when called to treat any wound from a cutting instrument or other weapon( not being a firearm) which he is not satisfied was accidentally incurred, or to treat any wound from a bullet, fails to advice the member of the police force incharge of the nearest police station by the most speedy method of correspondence, whether the same be by telephone, telegraph or letter.
How to break bad newsFirst, get a chair. Everyone must have a chair. When it comes to bad news, you must assert authority you didn’t know you had. Insist on having a private room. Move people out, clear a space. You can be a dictator. You get what you need by polite, quiet insistence.
Never give bad news standing up. Never, ever, ever give bad news in a hallway. As you’re getting the room, and the chair, people will become alarmed and ask you what has happened. You wait, saying you’d like to talk about it in private, please. You seat everyone. You take a deep breath, then you say it. And then, most importantly, you say you’re sorry.
You must keep in mind that only the first few words will be heard. After that, the mind shuts out the rest. Sometimes you hold a hand or pat a shoulder. Most of all, you wait. You wait some more. Often, like a trickle before the flood, there will be tears, then sobbing. Your job is to get tissues (if you have not thought to do so beforehand). If there is no crying, you let the silence stretch, no matter what else you have to do. If you have sadly forgotten to turn off your pager beforehand, you silence it if it rings. You can take these few moments for something this important.
Eventually there will be questions. You answer them with the facts you have, leaving out all interpretation, excuses, religion, or philosophizing.
references
http://www.nadrac.gov.au/http://www.aic.gov.au/publications/aust-violence-2/roberts.pdfhttp://books.google.com.au/books?id=NPi8YUWvKGEC&pg=PA44&lpg=PA44&dq=law+%2B+doctors+%2B+disclosure+%2B+patients+%2B+police&source=bl&ots=ZPDLyCAE3s&sig=WoNx3Cix9YEGYni0Xl3UQuskFF4&hl=en&ei=v2TLSYD6J4aMkAXwqKDeCQ&sa=X&oi=book_result&resnum=9&ct=result#PPA45,M1
http://www.docgurley.com/2008/01/19/how-to-break-bad-news/
