In the realm of healthcare, trust is the cornerstone of the patient-physician relationship. Patients rely on medical professionals to provide competent and compassionate care. However, as fallible humans, medical errors can and do occur. Recognising the importance of honesty and transparency, the concept of the “duty of candour” has emerged as a guiding principle within the healthcare community.
The UK General Medical Council has clear guidance on this, acknowledging that openness and honesty when things go wrong is a vital part of providing care. Obviously it is preferable that errors don’t occur but if we consider the way we go through process of consent for procedures we do acknowledge that risks are present in everything we do. But it is combined patient-doctor decision making that leads to weighing up of the risks and benefits and whether or not to proceed.
Defining the Duty of Candour
The duty of candour is a legal and ethical obligation placed upon healthcare providers to openly and honestly communicate with patients when harm resulting from healthcare has occurred. It encourages healthcare professionals to disclose incidents of medical error promptly, providing patients with accurate information about what happened, the potential consequences, and the steps taken to prevent recurrence. By doing so, the duty of candour aims to promote transparency, accountability, and learning within healthcare systems.
The Significance of the Duty of Candour
- Empowering Patients: Transparency is the key to empowering patients to make informed decisions about their healthcare. When healthcare providers disclose medical errors, patients gain a clearer understanding of their condition, potential risks, and available options. Honesty also demonstrates respect for patients’ autonomy, allowing them to participate actively in decisions related to their care.
- Improving Patient Safety: The duty of candour serves as a catalyst for learning from mistakes. When healthcare providers openly discuss medical errors, it creates an environment conducive to identifying the root causes and implementing necessary changes to prevent similar incidents in the future. Sharing lessons learned helps institutions improve their practices, thus promoting patient safety.
- Fostering Trust and Maintaining Relationships: Trust is the bedrock of the patient-physician relationship. Patients who receive honest and transparent communication about medical errors are more likely to trust their healthcare providers. By demonstrating a commitment to accountability, healthcare professionals can maintain the trust necessary for effective collaboration with patients.
- Ethical and Legal Responsibility: The duty of candour is not only an ethical obligation but also a legal requirement in many countries. Legislation mandating open disclosure of medical errors reinforces the importance of transparency and accountability. Failure to fulfill this duty may lead to legal consequences and professional disciplinary action.
Challenges in Implementing the Duty of Candour
While the duty of candour holds great potential, implementing it effectively can be challenging. Some of the key hurdles include:
- Cultural Resistance: The healthcare industry traditionally adopts a culture of secrecy around errors, fearing the impact on reputation and legal consequences. Changing this culture requires a shift towards embracing transparency and learning from mistakes.
- Fear of Litigation: Healthcare professionals often fear that disclosing medical errors may invite legal action. However, studies have shown that patients who receive open and honest communication are less likely to pursue legal recourse. Legal reforms and supportive policies can help alleviate this concern. However,
- Lack of Training and Support: Healthcare providers may require additional training and guidance on how to effectively communicate with patients about medical errors. Institutions should invest in educational programs and provide support to enable healthcare professionals to navigate these challenging conversations sensitively.
It is the fear of litigation that demands that the guidance and support around Duty of Candour be absolutely clear. We are fortunate that the General Medical Council clearly state
Apologising to a patient does not mean that you are admitting legal liability for what has happened. This is set out in legislation in parts of the UK and NHS Resolution also advises that saying sorry is the right thing to do. In addition, a fitness to practise panel may view an apology as evidence of insight. (see source)
However, this did not stop the General Medical Council bringing a doctor to task in case where a patients recollection of events was different to the contemporaneous notes made by the doctor. In that case the GMC opted to accept that the patients recollection superceded the documented notes, and the an apology made by the doctor was taken as an admission of guilt.
This is a frightening precedent.
Firstly, we are encouraged to keep thorough contemporaneous notes of all clinical interactions. These are, we are told and assured, legal documentation and will be reference for any past interaction. But it seems that a patients memory now supercedes it. Short of a video recording of the of the consultation that is then permanently stored we will not be able to challenge the recollection of the patient. Secondly, the GMC legal team went against their own guidance that an apology is not admission of legal liability but positive demonstration of insight.
The duty of candour represents a fundamental shift in healthcare culture, prioritising transparency, accountability, and patient-centered care. By embracing this obligation, healthcare professionals can foster trust, improve patient safety, and enhance the overall quality of care. Although challenges exist, implementing the duty of candour is essential to creating a culture of learning and continuous improvement within healthcare systems. By openly acknowledging and addressing medical errors, we can pave the way for a safer and more patient-centric future in healthcare.
But this can only be done when the legal profession and regulatory bodies focus building an open and honest culture. In light of the above issues, my practice of being open and honest won’t change. But I will continue to be extremely mindful about my interactions.
If my job is to have my patients trust so as to help them, who are we expected to trust?