Who Is Really the Communicator of Adverse Outcomes—And When?

Fritz et al.¹  studied surgical complications by reviewing the recollections of patients and by a retrospective chart review. Remarkably, not once does the word “surgeon” enter their discussion. That complications will occur is a given. There remain many issues attendant to disclosure of adverse outcomes. First, what one physician considers a complication may not be a complication in the eyes of another. Second, in an era of multiple providers dealing with complex cases, just who is charged with that difficult discussion is often problematic. There is much emphasis on handoffs from the Joint Commission, but there is no standard regarding explanation of complications as part of that process. Third, disclosing complications in the hospital environment may add to patient confusion, such that it may be better done late after hospitalization, at a time when the patient and extended family may be present, rather than during hurried 06:45 rounds. The authors focused on a 30-day window, but this may not be enough time for that discussion to have occurred with any hope that either understanding or resolution might result. Fourth is the question of just who should be disclosing a complication. In a large single-specialty group, in which I work, for example, the surgeons have different styles and opinions about disclosure of medical problems, just as we do not all agree on the management of a particular medical problem. For me, to discuss a partner’s complication would lead to much disharmony in the practice. This is not a theoretical issue. My group has experienced a malpractice suit as a result of how one doctor described another partner’s complication when the patient interpreted the situation as blaming and finger pointing. Fifth, the authors ignore the reality that often the people most interested and needful of that discussion about complications are the patient’s family or guardians. They were not surveyed for this study. Should they have been?

For an anesthesiology group to examine this problem raises a significant question: would older, experienced members of their Department of Surgery agree with their findings? Did they go to surgeons with these results and ask for change in the habits of their colleagues? Or, would the surgeons merely state that things are actually better than they have represented, and the anesthesiologists should deal with their own complications?

The author declares no competing interests.