OPEN DISCLOSURE

August 13, 2018 On 13 April 2018 the first Adrienne Cullen lecture took place in the University Medical Centre of Utrecht. Adrienne Cullen is a patient of whom a smear was taken for examination in 2011. The results, however, did not get transferred from the pathologist to the treating gynaecologist. It was only two years later that this error was discovered by chance. Meanwhile, the cancer had already spread in the patient’s body.

BENEFITS OF TRANSPARENCY

After the hospital initially refused to communicate about the error, it finally organised a public lecture (https://www.umcutrecht.nl/nl/Over-Ons/Nieuws/2018/Open-disclosure-UMC-Utrecht-geeft-openheid-in-fat). The patient, the attending physician and the head of the department explained what went wrong at the time and what consequences this had on their private lives and work. The lecture received the necessary attention in the media (see e.g. De Volkskrant, 13 April 2018; Mediquality, 23 April 2018). The initiative is remarkable. It is not often that a hospital and/or treating physicians openly admit mistakes. This requires courage. Concerns about reputation, fear of legal consequences, fear of negative attitude of the insurer, etc. are often reasons not to talk about mistakes (VERJANS, E., “Informatie van artsen over medische fouten en incidenten aan patiënten”, T. Gez. R., 2017-2018, p. 180). Yet transparency about incidents has many advantages. Patients are given the opportunity to receive the right treatment faster, patients would be less inclined to take legal action, physicians can emotionally deal with the incident in a better manner (VERJANS, E., p. 180) and the physician-patient's relationship can often still be maintained in case of transparency (VANSWEEVELT, Th. en PETITAT, V., “De erkenning van feiten en van fouten door een arts-verzekerde na een schadegeval”, T. Gez. R., 2003, p. 321).

POSITION OF PROFESSIONAL ORGANISATIONS

In an advice of 11 December 1999, the National Council of the Order of physicians already pointed out that in the event of a (suspected) medical error, a maximum information of the patient and/or his close relatives is deontologically appropriate and that no insurance provision may by any means hinder this open communication. The Dutch KNMG participated in a Code of Conduct on “open disclosure” in which the care provider is advised to contact the patient in the event of an incident with (possible) consequences for the patient as soon as possible and at the latest within 24 hours after discovery of the incident (https://deletselschaderaad.nl/downloads/GOMA1.pdf). If the investigation on the circumstances of the incident shows that there was indeed an error, the Code of Conduct states that the care provider must acknowledge this error and apologise to the patient. The KNMG realises that it is not easy for a physician to report bad news. The professional organisation offers physicians interesting tips that can help, see https://www.knmg.nl/advies-richtlijnen/dossiers/openheid-na-incidenten.htm. It is important that the hospital and/or physician take into account that after a mistake, the patient and his relatives need more attention than in a normal situation and that both patients and care providers on the contrary often tend to create distance between them.

GOOD FAITH AND OPENNESS

Open disclosure after an incident follows from art. 7, § 1 of the Belgian’s Patient Rights Act. This article stipulates that the patient has the right to obtain from the professional all information concerning the patient that is necessary to understand his/her state of health and its probable evolution. Moreover, the duty of transparency may be based on the complementary applicability of the principle of good faith in carrying out the treatment relationship as well as on a general standard of due diligence (VERJANS, E., p. 192). When acknowledging a mistake, a physician has little to fear from the insurer (VANSWEEVELT, TH. en PETITAT, V., p. 319). Even if the physician acknowledges not only a fault but also liability, it is very unlikely that the insurer will be able to successfully take action against the insured physician afterwards (VERJANS, E., p. 195).

P. 19 Artsenkrant 11 May 2018 | Nr. 2541