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“Non-Events” and Avoiding Reality
Susan K. Morash
Editors’ Note: What do you do when you think something should be discussed, but others don’t seem to recognize there’s an issue? This essay uses specific examples from health care to make a larger point. Only in recent years have health care professionals adopted standard policies against a former pattern, of choosing not to view supposedly-minor errors and “incidents” as triggering a need for a discussion with a patient. By taking the former view, of course, they had often set themselves up for confrontation or even lawsuits later, when and if the patient found out anyway. In reassessing her findings from 10 years ago, Morash finds there has been some progress, but not enough in practice. Furthermore, the intervening decade has presented society with all too many examples of “avoiding reality” and treating suspected harm to a third party as a “nonevent” in other fields, such as global finance. Do similar assumptions limit discussion with your kinds of clients? What are the consequences?
Much of the literature on negotiation, especially outside the spheres of international and race relations disputes, begins with an implicit assumption that the parties know when they are parties, and that the existence of a “negotiable event” is on the table for discussion by then, even if the merits are questioned. But there are situations where the knowledge that might give rise to the negotiation—or if there is no negotiation, perhaps, to a much more contentious dispute later—is in the possession of only the potentially “responding” party or person. How they react to this power, perhaps a very temporary power, has moral and often legal as well as practical implications. Health care practice abounds in these moments and is an excellent place to study them. This chapter will focus on health care settings, in order to permit a factually rich inquiry; but the reader is invited to assess whether she knows of similar problems and situations in her own field.
Background up to 2006
“Error … A commission or an omission with potentially negative consequences for the patient that would have been judged wrong by skilled and knowledgeable peers at the time it occurred, independent of whether there were any negative consequences” (Wu et al. 1997: 770).
In the 1990’s some highly publicized cases of serious malpractice, including a lethal overdose of chemotherapy to a prominent health reporter of a Boston newspaper, and the amputation of the wrong leg of a patient in a Florida hospital, came to the public’s attention. “These, and other sentinel events, were the impetus for the Institute of Medicine [IOM] Report, To Err is Human” (Correia 2002: 16). Data from this 2000 report indicate that the rate of adverse events in a hospital ranges from 2.9% to 3.7% of hospitalizations. The report also estimated that as many as 98,000 people die every year in the U.S. because of mistakes by medical professionals in hospitals (Kohn, Corrigan and Donaldson 2000). These shocking figures called for attention and immediate action concerning the problem of medical errors and adverse events occurring in our hospitals.
Talking about errors in practice is not easy for anyone, especially those who work in health care. Unfortunately, mistakes by health care workers happen with alarming frequency and are a common “shock and awe” event seen on nightly television news broadcasts and news magazine programs. These stories commonly describe extremely serious mistakes or even events that result in a patient’s death, and highlight a patient’s vulnerability when they are ill and under the care of medical personnel.
It is painful for anyone to admit their own error, especially to those patients who have been harmed by them. “Nevertheless, offering an apology for harming a patient should be considered to be one of the ethical responsibilities of the profession of medicine. Full and honest disclosure of errors is most consistent with the mutual respect and trust patients expect from their doctors” (Kalantri 2003).
New Standards of Care
The IOM’s report prompted calls for immediate changes in how mistakes are documented and reported to patients. In July 2001, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) responded by introducing new patient safety standards, including a requirement that all unanticipated outcomes of care be disclosed (JCAHO Standard RI.1.2.2). This standard clearly indicates that in addition to the....
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