The Agency for Healthcare Research and Quality

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The Persistent Challenge of Medical Errors: Impact, CANDOR, and Ethical Principles

Medical errors remain a significant challenge in healthcare, despite advancements in safety protocols and technology. These errors, occurring across all stages of care, have devastating consequences for patients, caregivers, and healthcare organizations. This discussion will explore common medical errors, their negative impacts, the CANDOR process for addressing them, and the ethical principles underpinning the physician-patient relationship.

Common Medical Errors:

Medical errors can occur at any point in the patient journey. Some common examples include:

• Assessment: Incomplete or inaccurate patient history, failure to perform necessary physical examinations, misinterpretation of vital signs, and inadequate documentation. For example, failing to recognize subtle signs of sepsis in a timely manner.
• Diagnosis: Misdiagnosis, delayed diagnosis, or missed diagnosis. This can stem from cognitive biases, lack of access to diagnostic tools, or misinterpretation of test results. An example is misdiagnosing a stroke as a migraine, leading to delayed treatment.
• Treatment: Medication errors (wrong drug, wrong dose, wrong route, allergies), surgical errors (wrong site, wrong procedure), and errors in therapy (e.g., radiation, physical therapy). Administering a medication a patient is allergic to is a classic example.
• Discharge: Premature discharge, inadequate discharge instructions, lack of follow-up planning, and communication breakdowns between inpatient and outpatient providers. Discharging a patient without ensuring they have necessary medications or understand their post-discharge care plan can lead to readmissions.
• Follow-up Care: Failure to schedule or attend follow-up appointments, lack of communication between providers, and inadequate monitoring of chronic conditions. A patient not receiving timely follow-up after a procedure and experiencing complications that go unnoticed exemplifies this.

Negative Impacts of Medical Errors:

The impact of medical errors ripples through the healthcare system, affecting:

• Patients: Physical harm, emotional distress, prolonged illness, disability, increased healthcare costs, and even death. The loss of trust in the healthcare system is another significant consequence.
• Caregivers: Increased burden of care, emotional stress, financial strain, and decreased quality of life. Family members often bear the brunt of managing the consequences of medical errors.
• Healthcare Organizations: Financial losses (increased costs, legal fees), reputational damage, decreased patient satisfaction, and staff morale issues. Medical errors can erode public trust in an institution.

The CANDOR Process:

The CANDOR (Communication and Optimal Resolution) process is a framework designed to improve how hospitals respond to unexpected patient harm events. It emphasizes:

• Prompt and Transparent Communication: Openly communicating with the patient and family about what happened, acknowledging the error, and expressing empathy. This includes providing a factual account of the event and what is being done to investigate it.
• Comprehensive Investigation: Conducting a thorough and unbiased investigation to determine the root causes of the event. This includes gathering information from all involved parties and analyzing system factors that may have contributed.
• Apology and Remorse: Expressing sincere apology and remorse for the harm caused, without admitting legal liability. This acknowledges the patient's suffering and demonstrates accountability.
• Offer of Resolution: Offering fair and timely resolution, which may include financial compensation, without requiring the patient to file a lawsuit. This aims to provide a more just and efficient way to address harm.
• System Improvement: Using the information gained from the investigation to identify system vulnerabilities and implement changes to prevent similar events from occurring in the future. This focuses on learning from errors and improving patient safety.

The CANDOR process aims to shift the focus from litigation to learning and improvement. By fostering open communication and offering fair resolution, it can potentially reduce the likelihood of malpractice lawsuits and improve patient satisfaction.

Principles of Medical Ethics and the Physician-Patient Relationship:

The physician-patient relationship is built on several key ethical principles:

• Autonomy: Respecting the patient's right to make informed decisions about their own care. This requires providing patients with adequate information and ensuring they understand their options.
• Beneficence: Acting in the best interests of the patient. This involves providing competent and compassionate care.
• Non-maleficence: Avoiding harm to the patient. This principle underscores the importance of patient safety and error prevention.
• Justice: Ensuring fair and equitable access to healthcare resources. This addresses disparities in care based on factors like race, ethnicity, or socioeconomic status.

These principles are essential for building trust and fostering a therapeutic relationship between physicians and patients. Open communication, shared decision-making, and a commitment to patient well-being are fundamental to ethical medical practice. When medical errors occur, adhering to these principles is crucial for maintaining trust and working with patients to achieve healing and resolution. The CANDOR process aligns with these principles by emphasizing transparency, accountability, and a commitment to patient well-being.