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“An error has occurred...”

The situation

The patient, Mrs. Grant, has received the wrong dose of chemotherapy, resulting in life-threatening consequences. In this scenario, the physician must inform her son of the medical error.

Communication issues

Disclosure of medical errors is a painful conversation for the doctor. CONESCurrent practice norms however, obligate him to do so. Research has shown that prompt disclosure can actually reduce the size of malpractice settlements, while maintaining a relationship with the patient and family. In this vignette, the physician uses the protocol we have called 'CONES' to manage an interaction with an understandably angry son.

CONES is a variation of SPIKES that can be used in situations where a disclosure must be made. Since there is no initial "perception" to explore, and an 'invitation' is not relevant here, these steps are replaced by an opening, or warning statement before the information is given.

Emotion is bound to be part of the discussion, so all of the techniques you may have seen here for dealing with emotion are relevant.

What to watch for

Watch for the ‘O’ (Opening shot) the ‘N’ (Narrative) and the ‘E’ (addressing Emotions).

Also note that in this scenario the physician takes the cue from the patient's son that it is he, and he alone, that the son wants to communicate with. He then acts upon that cue to make arrangements to provide ongoing information and contact with the family, which becomes the ‘S’ for Strategy and Summary.

VIEW Vignette: An error has occurred... (5:57)
Pearls & Pitfalls: Expert Comment (4:51)


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