Dealing with Guilt, Isolation and Fear when Adverse Medical Events Happen

I recently attended a forum entitled Medical Error: The Power of Apology, Action and Forgiveness. Paul Levy, CEO of the Beth Israel Deaconess Medical Center in Boston (BIDMC) led off the program with a discussion of his initiative to make public all occurrences of preventable medical events at the BIDMC. Levy pointed out that hospitals are the fourth ranked health hazard in the nation! He recommended a “laser-like” focus on quality that engages all stakeholders in healthcare that might help ameliorate this outrageous statistic. www.runningahospital.blogspot.com

Dr. Tom DelBanco, M.D., Professor of General Medicine and Primary Care, at Harvard Medical School was the lead speaker at this forum. For over 30 years Dr. DelBanco was Chief of the Division of General Medicine and Primary Care at the BIDMC. He is also a founding Chair of the Picker Institutes in the USA and Europe, an organization that documents patient experiences with care and works with patients to improve health services.

Dr. DelBanco reminded us that patients or care givers advocating for patients who have been injured in the health care system often suffer guilt, fear and isolation when an adverse event occurs. These emotions are equally shared by the doctors and nurses who have been involved in medical errors. Dr, DelBanco pointed out that disclosure and communication could effectively help resolve the emotions that surface after these occurrences. His talk was followed by two patient presentations whose horrific experiences with medical errors were a powerful reminder of how things can go wrong without intent or provocation and how those wrongs could have been made tolerable if the doctors had admitted their error, showed compassion and maintained communication with their patient.

As an individual whose career has been devoted to understanding communication, teaching communication skills and using communication tools, I see a unique opportunity for healthcare institutions to attack the syndrome of emotions resulting from an adverse medical event by: (1) implementing high standards-based quality measures that help to insure that everything humanly possible is in place to avoid these medical errors and (2) providing training to healthcare professionals in the elements of communication. In times of stress, when guilt, isolation and fear overtake the individual who realizes that a mistake has been made, the tendency is to avoid all contact with the problem.

In the digital era we run the additional risk of increasing the communication gap between patients and doctors as one-on-one interactions are replaced with virtual interactions. Open communication will not come about by itself. A deliberate and thoughtful plan is needed to help healthcare staff learn how to explain these situations and talk through these issues with patients. Encouraging those difficult conversations will go a long way in making everyone feel better about themselves and the situation.