In family medicine like in other medical specialties, errors happen quite commonly. These errors could touch different aspects of day-to-day tasks and be errancies in communication, administration, documentation, diagnosis or medication. Each error has its own particularities. Therefore, it is important to understand errors in communication and the factors that can contribute to them in the hope that looking into these will reduce them.
Defining what constitutes a medical error is a challenge. Some features of its definition could include the fact that it is preventable and that patient harm does not have to be necessarily present. Notably, in Quebec, article 56 of the Quebec Code of Ethics of Physicians obliges the physician to “inform his patient or the latter’s representative of any incident, accident, or complication which is likely to have or has had a significant impact on his state of health or personal integrity”. This underlines the importance of open and honest communication with patients.
The high workload and the fatigue that can affect some family physicians could be causal factors for lack of communication. Other factors could include having insufficient information about patients, about future investigations or about treatments. Some investigations or treatments that seem benign such as lumbar punctures and liver biopsies may result in considerable complications or side effects. Poor outcomes can surprise patients and they might suspect medical errors. A detailed discussion of the benefits and risks of an investigation or treatment between physicians and patients can prevent these kinds of misunderstandings. Moreover, as the desirable outcome is not always attained and if harm occurs, physicians have to provide information to the patient and should be as supportive and open as possible. Communication is the right way of sailing these waters and helps to maintain trust and to strengthen the relationship between physicians and patients. Of course, if the patient is not competent, communication and collaboration with a substitute decision maker is required.
Communication between family physicians and other healthcare providers (e.g., emergency departments, hospitals, pharmacists, dentists and other specialists) should also be well organized to maximize quality of care and achieve the best possible outcomes for patients. This includes properly and legibly documenting information on patients. For instance, information about the diagnoses and treatments of patients visiting emergency departments or those who were hospitalized should regularly be conveyed to their family physicians.
Alain Nathan Sahin
Second Year Medical Student
Montréal Campus of Université de Montréal
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