Apologies abound: advances in adverse-event disclosure

Canadian physicians seeking to improve communication with patients who have been harmed are getting plenty of assistance.

Ontario late last year became the fourth province to unveil apology legislation, while the Canadian Patient Safety Institute and the Canadian Medical Protective Association released guidelines for disclosing harm to patients.

The measures are complementary, since the intent of the guidelines is to “remove concerns about potential legal liability and other sanctions” when health professionals tell patients about harm, says Brent Windwick, chair of the Institute's legal and regulatory affairs advisory committee.

Windwick warns that apology legislation does not remove the need for effective and thorough training for health professionals about how to tell patients about adverse events. But it will “remove a significant source of hesitation” about speaking to patients who have suffered harm.

British Columbia was the first province to pass an apology act, in 2006, with Manitoba and Saskatchewan following suit in 2007.

But it's too early — and may never be possible — to credit Canadian legislation with having a clear impact on the number of medical–legal cases, says Dr. William Tucker, president of the protective association.

Expressions of sympathy can improve relations, he adds. “Families feel better if there is an acknowledgement that there has been an adverse event” and, after expressing regret and sympathy, it may be easier for a physician to carry on the therapeutic relationship.

If passed, Ontario's legislation will “promote accountability, transparency and patient safety by allowing open and frank discussions,” according to a spokesman for the province's Ministry of the Attorney General.

Canadian apology legislation is broader than legislation in some Australian and US states where laws deal only with “expressions of regret” and stop short of addressing the issue of apology, says Windwick.

At its 2008 annual meeting, the Canadian Medical Association voted to lobby governments for appropriate apology legislation in all Canadian jurisdictions.