Managing mountains and molehills

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Durham, N.C. - Avoiding a malpractice suit as a result of an unanticipated outcome or medical error requires a degree of openness before, during and after the incident, an expert says.

"There are two kinds of unexpected outcomes in medical practice - when there's been a mistake, and when there hasn't been a mistake," says Neil Prose, M.D., director, pediatric dermatology, Duke University Medical Center, Durham, N.C.

In either case, he tells Dermatology Times, "It requires a great deal of empathy and understanding to help patients navigate the situation, understand what's going on and feel OK about where to go from there."

Errors happen, but ...

By now, everyone knows medical errors are fairly common - in fact, they're the eighth leading cause of death in the United States, Dr. Prose says.

Furthermore, he adds that when an unanticipated outcome occurs, patients may experience disappointment not only with the results, but also over how doctors handle the situation.

"Sometimes the second disappointment is much worse than the first," Dr. Prose adds.

When patients sue their doctors, he says, "It often has to do with the fact that they felt they weren't listened to or told the truth about what happened to them."

Therefore, he says that for ethical, legal and moral reasons, "We're by and large required to be truthful and transparent with our patients. And if something went wrong, it's in our best interest to tell them as quickly and effectively as possible what it was and how it happened."

Examples of unanticipated outcomes that can occur without medical mistakes include problems that result from biological variability or low probability risks and side effects, Dr. Prose notes.

"Clinicians have more experience discussing such cases and can usually work through them on their own" with no responsibility to compensate patients, he adds.

Conversely, "Unanticipated outcomes with medical error challenge a physician's integrity, courage and humility," Dr. Prose says. Additionally, they require involvement of others and sometimes offers of compensation, he says.

Involve patient, family throughout treatment

The first steps toward addressing disappointing results begin long before any treatment or procedure, Dr. Prose says.

"When making a decision about a medical treatment," he explains, "involve the patient in a partnership - explain the reason for doing it and the possible risks," then stop and ask the patient to decide collaboratively whether it's the right thing to do. "Even though one might need a consent form for surgery," he observes, "the discussion that preceded the surgery is much more important" than the form.

If a family or patient calls to report a medication reaction or an apparent problem after surgery, "It requires a special amount of attention to make sure one understands the story" and offers the option of returning to the office as soon as possible, Dr. Prose says. "Show empathy and concern and negotiate a plan."

Deal with unexpected outcomes
When it's clear that an unanticipated outcome has occurred, Dr. Prose recommends the following steps: