Sadly, too many patients and too many doctors and nurses do not navigate end-of-life care issues succinctly or even compassionately, and failure to do so can result in enormous distress for patients, family members and clinical staff. This failure to discuss, to share thoughts and to candidly communicate also can result in harm and even litigation. This is especially the case when there is confusion about what has been said or agreed upon and when there is disagreement amongst family members about the best courses of action for severely impaired relatives incapable of making their own decisions1,2.
Our ability to communicate effectively and compassionately in a multicultural society is influenced by many factors. Our ability to be successful requires us to be diligent and to avoid biases and stereotyped assumptions that colour our perceptions and encumber our efforts. We need to stop assuming we know things that we do not know and must recognize how damaging our erroneous assumptions can be.
The Government of England recently passed legislation requiring institutions to inform patients, and/or other appropriate parties, of instances where patients have been harmed as a result of “errors”. The term “error” has always troubled me because it imparts a flavour of blame. Although many patient safety incidents may be due to “errors”, others arise due to system and/or human inefficiencies or insufficiencies; and often numerous contributing factors align in the final causality of harmful incidents.
“Doctor, what would you do if Sally were your child?”
Hospitals are dangerous, encumbered by system inefficiencies and human factors affecting performance. Despite all the hazards in the hospitals we do not generally ask patients to acknowledge this. Patients give consent for many aspects of care by simply agreeing to be admitted.