POLICY MATTERS
Disclosure of harm
Disclosure integral to promoting patient autonomy, maintaining trust
P
hysicians, no matter how strong their
commitment to excellence, will likely,
at some point in their career inadver-
tently contribute to an incident that
leads to harm or potential harm to a patient. In
fact, harm can also occur through the delivery
of care itself, usually from the inherent risks of
investigations and treatments. So while harm
is not always preventable, nor necessarily an
indicator of substandard care, its impact can
deeply affect patients and their families. As such,
physicians have both legal and professional du-
ties to disclose harm that occurred in the course
of medical treatment.
The College is now consulting on draft
professional expectations that build upon
physicians’ legal obligations and we want your
feedback to ensure that the policy is practical,
relevant and reasonable. The expectations in
the updated Disclosure of Harm draft policy
reflect the principles that full disclosure helps
foster openness, transparency, and good com-
munication in the delivery of medical treat-
ment. These are integral to promoting patient
autonomy and maintaining trust, both in the
physician-patient relationship and the medi-
cal profession generally.
When you read the draft Disclosure of Harm
policy online, you will note that the policy has
also been redesigned, in accordance with our
new policy design strategy (see page 24), to
enhance its clarity and readability. As such, the
policy focuses on clearly setting out expectations
of physicians, i.e., to whom to disclose, when to
disclose, what to disclose and who must disclose,
as well as the need for quality documentation.
Although the draft generally maintains the
expectations set out in the current policy, clari-
fications and additions have been made. These
include:
• a reframing of expectations to align with the
World Health Organization’s terminology on
patient safety and disclosure: harmful incident,
no harm incident, and near miss incident;
• a clarified expectation regarding disclosure
where a patient has died and there is no estate
trustee;
• a new expectation that subsequent physicians
disclose, to the extent they can, incidents
where the previous physician is no longer
available;
• a new expectation to consider whether an
apology is appropriate in the circumstances;
• a clarified expectation addressing the role
of the Most Responsible Physician (MRP)
in facilitating a postgraduate learner’s
disclosure.
A draft companion document addresses the
principles underlying disclosure expectations,
timing of disclosure obligations, and the
role and value of apologies. It also provides
examples of the types of incident that must be
disclosed under the policy.
Please read the draft policy online at www.
cpso.on.ca and let us know what you think.
Your opinion is important to us.
MD
ISSUE 2, 2019 DIALOGUE
27