title: Disclosing adverse events to patients.
abstract: BACKGROUND
  The rationale for, and recommended approaches to, disclosing adverse events to patients are examined on the basis of the experience of the Veterans Health Administration (VHA). The VHA's National Ethics Committee endorses a general policy requiring the routine disclosure of adverse events to patients and offers practical recommendations for implementation.
  Disclosure is required when the adverse event (1) has a perceptible effect on the patient that was not discussed in advance as a known risk; (2) necessitates a change in the patient's care; (3) potentially poses an important risk to the patient's future health, even if that risk is extremely small; (4) involves providing a treatment or procedure without the patient's consent. From an ethical perspective, disclosure is required and should not be limited to cases in which the injury is obvious or severe. Disclosure of near misses is also discretionary but is advisable at times. In general, disclosure by a clinician involved in the patient's care is appropriate.
  
  
  CONCLUSIONS
  Although a variety of psychological and cultural factors may make clinicians and organizations reluctant to disclose adverse events to patients, the arguments favoring routine disclosure are compelling. Organizations should develop clear policies supporting disclosure and should create supportive environments that enable clinicians to meet their ethical obligations to disclose adverse events to patients and families.
authors.affiliation: VA New England Geriatric Research, Education, and Clinical Center, Boston, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cantor
authors.forename: Paul
authors.initials: P
authors.lastname: Barach
authors.forename: Arthur
authors.initials: A
authors.lastname: Derse
authors.forename: Claire W
authors.initials: CW
authors.lastname: Maklan
authors.forename: Ginger Schafer
authors.initials: GS
authors.lastname: Wlody
authors.forename: Ellen
authors.initials: E
authors.lastname: Fox
mesh_terms: D005190:Family; D006801:Humans; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D014342:Truth Disclosure / Q000941:ethics