Open Communication Softens Impact of Medical Errors on Patients and Families

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By Christopher Cheney

Open communication with patients after medical errors decreases emotional impacts and diminishes patient avoidance of doctors and organizations involved in errors, new research indicates.

Earlier research found that about one-quarter of Massachusetts adults had been personally involved in a medical error incident in the previous five years. Errors have been linked to emotional, financial, physical, and socio-behavioral effects such as decreased trust and willingness to seek medical services.

The new research, which was published by BMJ Quality and Safety, produced several significant findings, the study’s co-authors wrote. “Our findings highlight substantial persisting emotional harm, healthcare avoidance, and loss of trust in healthcare among 253 patients and family members who self-reported an experience with medical error up to 6 years ago.”

Research results

The study features survey and interview data collected from 253 Massachusetts adults who had experienced a medical error personally or through a family member. Open communication was defined with six elements, including acknowledgment of the error, whether the error was discussed openly and truthfully, and whether the error was discussed in terms that were easily understood.

The research generated several key data points.

  • 41% of the subjects reported the medical error occurred in a hospital inpatient setting
  • 27% of the subjects reported the medical error occurred in an ambulatory care setting or doctor’s office
  • A significant proportion of subjects reported physical impacts of medical errors persisted for years. For subjects who reported experiencing a medical error in the prior year, 42% said there were ongoing physical impacts such as loss of function. For subjects who reported experiencing a medical error in the prior 3-6 years, 27% said there were ongoing physical impacts.
  • Emotional impact was also persistent for years. For subjects who reported experiencing a medical error in the prior 3-6 years, 51% said they had at least one emotional impact from the error. Emotional impacts in the research included anxiety, anger, depression, feelings of abandonment or betrayal by the doctor, and sadness.
  • The impact of medical errors on healthcare avoidance persisted for years. For subjects who reported experiencing a medical error in the prior year, 45% said they had avoided medical care. For subjects who reported experiencing a medical error in the prior 3-6 years, 37% said they had avoided medical care.
  • The impact of medical errors on erosion of trust in healthcare also persisted for years. For subjects who reported experiencing a medical error in the prior year, two-thirds said they had lost trust in healthcare. For subjects who reported experiencing a medical error in the prior 3-6 years, 67% said they had lost trust in healthcare.
  • There was significant variation in subjects receiving the six elements of open communication examined in the study. The most common form of open communication was an offer to ask questions about the medical error, at 46% of subjects. The least common form of open communication was acknowledgment that an adverse event was an error, at 29% of subjects.
  • Open communication lowered most emotional impacts of medical errors. For subjects who received no open communication, 33% to 52% reported persistent abandonment, anger, depression and sadness. For subjects who reported at least five of the six kinds of open communication, persistence of abandonment, anger, depression and sadness was less than 10%.
  • For subjects who received no open communication, 77% to 80% said they had avoided doctors and healthcare facilities involved in a medical error. For subjects who reported at least five of the six kinds of open communication, 30% or less avoided doctors and healthcare facilities involved in a medical error.

Open communication has limits, the researchers wrote. “Open communication is not a panacea. Our findings suggest that it does not protect against persistent anxiety, avoiding medical care in general, or loss of trust in healthcare. All three outcomes reflect a common factor—lost faith in the efficacy and safety of medical care.”

Boosting open communication

The study suggests a possible solution to improve communication about medical errors and decrease the negative effects, the researchers wrote. “Communication and resolution programs (CRPs), not yet widely implemented, could increase open communication through structured disclosure practices, reducing some of the negative impact of medical error on patients and families.”

CRPs have several primary elements, they wrote.

“These programs facilitate transparent conversations about disclosures and apology, and [they] provide compensation for patient injuries when appropriate. In addition, CRPs may need to adopt a comprehensive communication approach that acknowledges the error, explains what happened and why, provides an apology, … and explains how recurrences will be prevented.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.