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Published on: February 16, 2011
Adverse events and perceived abandonment: learning from patients' accounts of medical mishaps
Mark Schlesinger1, Isha Dhingra2, Barbara A Fain3
1Yale University Yale School of Public Health, New Haven, Connecticut, USA.
Background:
Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed.
Objective:
To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment.
Methods:
Mixed-methods analysis of responses to the Massachusetts Medical Errors Recontact survey with participants reporting a medical error within the past 5 years. The survey consisted of forty closed and open-ended questions examining adverse medical events and their consequences. Respondents were asked whether they felt 'that the doctors abandoned or betrayed you or your family'. Open-ended responses were analysed with a coding schema by two clinician coders.
Results:
Of the 253 respondents, 34.5% initially and 20% persistently experienced abandonment. Perceived abandonment could be traced to interactions before (18%), during (34%) and after (45%) the medical mishap. Comprehensive post-incident communication reduced abandonment for patients staying with the provider associated with the mishap. However, 68.4% of patients perceiving abandonment left their original provider; for them, post-error communication did not increase the probability of resolution. Abandonment accounted for half the post-event loss of trust in clinicians.
Limitations:
Survey-based data may under-report the impact of perceived errors on vulnerable populations. Moreover, patients may not be cognizant of all forms of adverse events or all sequelae to those events. Our data were drawn from a single state and time period.
Conclusion:
Addressing the deleterious impact of persisting abandonment merits attention in programmes responding to patient safety concerns. Enhancing patient engagement in the aftermath of an adverse medical event has the potential to reinforce therapeutic alliances between patients and their subsequent clinicians.
Insights
Medical errors can lead to feelings of abandonment, impacting patient trust and provider relationships. Addressing patient abandonment is crucial for improving safety and rebuilding therapeutic alliances after adverse events.
Area of Science:
- Healthcare quality and patient safety
- Medical ethics
- Health services research
Background:
- Adverse medical events impact numerous American households annually, causing harm and altering patient attitudes.
- The effect of medical errors on patients' and care partners' feelings of abandonment remains under-assessed.
Purpose of the Study:
- To explore provider, patient, and family responses to medical mishaps.
- To link these responses to feelings of abandonment and its consequences.
Main Methods:
- A mixed-methods analysis of the Massachusetts Medical Errors Recontact survey data.
- Included 253 participants who reported a medical error within the past five years.
- Utilized closed and open-ended questions, including specific queries about feelings of abandonment, with qualitative coding of responses.
Main Results:
- 34.5% of respondents initially felt abandoned, with 20% persistently experiencing this feeling.
- Perceived abandonment stemmed from interactions before (18%), during (34%), and after (45%) the medical mishap.
- Patients perceiving abandonment were significantly more likely to switch providers (68.4%), and abandonment accounted for half of the post-event loss of trust.
Conclusions:
- Addressing patient abandonment is vital for patient safety initiatives.
- Enhanced patient engagement after adverse events can strengthen therapeutic alliances.
- Survey data may underestimate the impact of errors on vulnerable populations.
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