Journal of Clinical Research & Bioethics

A Medical Error: To Disclose or Not To Disclose

Samreena Ghafoor^* Department of Nursing, Punjab Institute of Mental Health, Lahore, Pakistan
^*Correspondence: Samreena Ghafoor, Department of Nursing, Punjab Institute of Mental Health, Lahore, Pakistan, Email:

Received: 16-Feb-2021 Published: 09-Mar-2021, DOI: 10.35248/2155-9627.21.s10.e002

Introduction

Ethics is base of respectful survival of humanity. Ethics and moral behavior helps the health care organization to achieve the provision of the excellent client care in much safer environment. History of ethics is ancient and ethics have been applied in health care system since 4000 years. It cannot be denied that health professionals face many ethical issues and challenges on daily basis, and they used to resolve those challenges by using ethical principle [1,2].

HCP are bound to provide health services to meet the code of ethics. Ethics has become the well-known part in the health care organization’s mission statements, and health professional’s oaths and declaration. Health care organization developing the programs to promote the patient safety and avoiding the medical error [3,4].

Unfortunately, medical errors are not reported on routine basis the way they should be reported. Due to low reporting of the medical error, Errors are repeating day by day HCP can control medical errors in a better way by developing the numbers of strategies how to prevent malpractice [4].

Patient and HCP have a relationship which is based on trust which justifies ethical principle of non-maleficence. Patients think that their physician will take care of them, will save them from harm, and will promote their health. But, if HCP will start giving them harm even to a newborn baby and at the top they hide their mistakes then the organization will take strict action against them [5].

Furthermore, one most important ethical principles is veracity which ensures that the true information has been communicated to the patients and his family.it always gives positive impact in resolving the ethical dilemmas, but if veracity is violated it may create negative impact for both health organization and HCP [6].

In given scenario if the HCP was admitted her fault and conveyed the all true information to the patient’s family, it may might have saved the family and new born baby from further suffering and intense pain of fracture.

Scenario

A 39 years old pregnant lady presented to the hospital with labour pains. She delivered a baby and discharged to home. Baby use to cry continuously for which family brought home to the pediatrician after examination pediatrician was unable to diagnose properly and sent them back to home his mother noticed that something wrong with his right and took him to the doctor who advised X-Ray of right leg. X-Ray report revealed that right leg was fractured. This was terrible news for the family. Later on, Family realize about the obstructed labor and during delivery his leg got fractured and doctor hide this situation.

Due to this negligence, family experienced difficulties and pain just because of immoral act of the Health Care Provider HCP! Family filled an incident to hospital but the organization didn’t pay the considerable attention.

Newborn innocent baby and his family face trouble and pain just because of unethical behavior of the Health care provider (HCP) after this incidence and diagnosis family submitted request to hospital with reports of baby but the organization did not pay considerable attention to this issue this is the only one case, No one can imagine how other patient’s rights were violated by the HCP every minute in a well reputed hospital.

From the Lens of Health Care Organization

In reputable health care settings, HCPs must adopt the ethical rules and policies of organization which bound them to consider the client moral and ethical beliefs. They take care of their client with honesty and peaceful mind by obeying all ethical principles. HCPs can perform their duties more accurately if the health care organizations have clear polices and standards. Furthermore, if the health care organizations allow HCP to make own decision other than focusing on organization standards and policies, it may lead to malpractice and harm to the patient [7].

There is a deep connection between malpractice and patients wellbeing. But, there is no doubt that HCP should feel free about taking the decision regarding patient health and disease prevention but they should not be encouraged to do mal practices and to ignore the patient safety [8].

In our scenario, HCP should report the medical error immediately, rather than hiding the mistake that caused more suffering and pain to baby and his family. The scenario validate that the HCP’s act went against the rules of organization which can put on risk organizational rotation on risk.

On the other hand, fear of malpractice litigation discourages HCPs to report such error. But, system of malpractice litigation. The goals of Heath care organizations are based on patient’s health promotion, prevention of medical error, minimizing the patients harm, and maximizing the patient’s safety culture these elements should become the part of organization policies to reduce the numbers of errors. Health care organization should make some polices to disclose the medical error and patients injuries to authorities [9].

From the Lens of the Patient

Morality and ethics is deep rooted in every HCP’s practices by concerned professional codes. Ethical codes should be the first priority of every HCP. Otherwise, it may violate the principal of non-maleficence. If the HCP does not fulfill then she/he might be directly violating his or her pledge of not to harm the patients [10].

The relationship between HCP and patient based on trust which cannot be successful until all ethical principles(autonomy, Non maleficence, beneficence and justice), and rules (fidelity, confidentiality, privacy, and veracity) they do not employ even one ethical principle of non-maleficence, then it may not only cause feeling of insecurity but it can harm the patient. Although, it was a medical error which undoubtedly was done un deliberately but it should be report on immediate basis so that corrective measure could have taken to prevent such an event in future [5].

From the Lens of the Family

Addressing the ethical codes which include, do not harm the patient, doing maximum good for the patient, keeping the secrets of the patient with telling the truth to the patient and his family is very important and telling the truth is needs good communication skill and practice and no doubt reputation of health care setting and HCP who are telling the truth is accountable. Telling the truth to the patient and his family increase the trust level on HCP [6].

Furthermore, if medical error occurs it should be disclose to the family it is ethical obligation of HCP. Although, Medical error disclosure have both negative and positive consequences. In last decay, the disclosure of medical error was not acceptable socially but the situation has been changed now a day. Best way to disclose the medical error is to apologize. Apologetic way is always helpful can minimize the family aggression, can decrease blame, Encourages the patient trust, and promote patient and HCP relationships. Importantly, apologies can also minimize the risk of medical error and lawsuit, But HCP should explain medical error and apologize [11].

Organization should also make some protocols how to explain medical error this will not only help the HCP to disclose the medical error but it will also decrease the number of medical error [12].

Justification of My Position

My point of view is strongly in favor of making policies on administrative ground to explain the mal practice to the patients and attendants. When health care organizations make policies to face the consequences upon mal practice in better way, this will encourage the HCP to admit their mistake and this will improve their spirit to work for the maximum benefits. If we analyze, HCP did not harm the patient intentionally, this was done by chance but the element of negligence is still a question mark. The HCP should have admitted fault and tried to convince the patient’s family. But, on the other side, family might respond in a threatened way while prevent HCP to disclose such information. This acceptance has to be developed in our population that when humans are involve in any action it carries a risk of error so that the capacity to tolerate such medical errors would be developed in our population which will increase the number of reporting because this will only the fear of family’s response which prevents HCPs from reporting such errors.

Possible Consequences

This ethical dilemma between three ethical malpractices, Non maleficence and one was veracity. This immoral act of HCP against non-maleficence and veracity may spoil the reputation of the organization. This type of malpractice and negligence of HCP may lead to deal with lawsuits. On the other hand moral actions may alleviate patient’s suffering and may take ethical problems away which can save the organization as well HCP from serious consequences [12].

Recommendations

HCP and health care organization used to encounter ethical challenges on daily basis. Health care organization should develop policies and strategies to resolve the ethical dilemmas effectively without violating the ethical principles. There should be some mechanism for reporting medical error due to employees reports rather threatening them which could led them think weather to report or not. Furthermore, better communication between the HCP will be really helpful to report such errors so that SOP could be developed to reduce the number of such incidents.

Conclusion

Unresolved ethical dilemma becomes the question mark over reputation of the organization. Unethical decision making of the HCP may bring them to lawsuits even to the cancelation of their licenses. Development of the policies and professional training of the HCP will result in better management of such ethical problems. Although with that, if we consider the patient’s right, it will increase the level of patient satisfaction which will also ultimately the image of the organization.

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