An Error has Occurred...
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.
Disclosure of medical errors is a painful conversation for the doctor. Current 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.
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Certain material on this site is available for Risk Management Education Credit for physicians enrolled in the The University of Texas Professional Liability Insurance Plan only. To obtain credit you must use the “Earn Free Risk Management Credit Online” link on the left. RME is only available to those who have UT Professional Liability Insurance.
Applying for both CME and RME?
If you are applying for both CME and RME for the same module, you MUST view the video through the CME link The Fundamental Principles section and Managing Difficult Communication section will now allow you to register and print both RME and CME certificates upon completion of the module. All other modules you must view the videos and then print both the CME forms (found on the right side of the video page) and the RME forms (found below the video window) and send to the appropriate offices. NOTE: RME is only available to those who have UT Professional Liability Insurance.