Dialogue Volume 15, Issue 2 2019 - Page 27

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