Duty of candour
Duty of candour is a legal obligation in the United Kingdom requiring medical professionals to be transparent and forthcoming with patients and their families when a medical error has resulted in significant harm. This duty mandates that healthcare providers admit to the error face-to-face, issue a personal and written apology, and offer necessary support to those affected by the mistake. Medical errors can have serious consequences; studies indicate that they are a leading cause of death and injury within healthcare systems, prompting the need for accountability and honesty in patient care.
Established in November 2014 and fully implemented by April 2015, Duty of candour aims to enhance transparency in the National Health Service (NHS) and promote a culture of learning from errors to improve patient safety. The law not only requires open communication about the errors but also entails ongoing updates regarding the patient’s situation and actions taken to prevent similar incidents in the future. Furthermore, it acknowledges the emotional toll on healthcare providers involved in such errors, ensuring they receive support as well. Advocates believe that this duty fosters a more careful approach to patient care, while critics raise concerns about potential misunderstandings and unrealistic expectations among patients. Overall, Duty of candour represents a significant step toward greater accountability in healthcare practices.
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Duty of candour
Duty of candour is a legal requirement in the United Kingdom that medical professionals be open and transparent with a patient and the patient's family when a medical error has caused the patient significant harm. The duty includes specific legal responsibilities to admit the error face to face and to apologize to the patient and/or the patient's family in person and in writing. Any support needed by the patient and/or family to deal with the consequences of the error must be provided, and the patient or family must be kept apprised of any updates or new information. The law also requires medical professionals to report errors when they become aware of them and encourages support for professionals involved in the error, who might be traumatized by the consequences of the mistake.
Background
Duty of candour requirements were passed in the United Kingdom in November 2014. The duty was passed as a way of improving the transparency of the National Health Service (NHS), the publically funded health care system available to UK citizens since 1948. Proponents of the requirement sometimes referred to it as Robbie's law, after Robbie Powell. Powell was a ten-year-old boy from Wales who died in 1990, even though his condition was treatable and multiple physicians saw him in the days before his death. An inquest in 2004 revealed the medical errors that contributed to his death, and government officials apologized to the Powell family in 2012. They also commissioned an investigation into the situation to see how the national health care system could be improved.
Medical errors are a relatively common problem in modern health care. A study conducted by experts from Johns Hopkins University and published in the British Medical Journal in May 2016 reported that medical errors were the third most common cause of death in the United States, responsible for 250,000 deaths annually, or 10 percent of deaths in American hospitals. A study published by the London School of Hygiene and Tropical Medicine in 2012 found that nearly 12,000 people died in United Kingdom hospitals annually as a result of medical errors. The same British study estimated that one out of every ten hospital patients was affected by some type of medical error, including nonfatal errors. Errors included not assessing patients closely enough during admittance to identify all underlying causes of the condition, not adequately monitoring key factors such as blood pressure or response to medications, and the incorrect prescribing of medications.
The United Kingdom duty of candour requirement came into full effect in April 2015. Proponents say that having access to truthful and complete information is helpful to patients and their families who are affected by medical errors. They say it provides peace of mind and comfort in knowing that health care providers may learn something as a result of what patients have experienced. It also provides motivation for providers to be more diligent and attentive in providing care.
Overview
The duty of candour outlined the legal obligation of medical and mental health providers to notify patients and/or their families of medical errors as well as the requirements of those notifications. While being honest and up front about any mistakes in patient care was always the ideal, the law made it mandatory that health care providers report errors when they were identified, notify the patient and/or family that an error had occurred, explain what effect it had on the patient, and apologize to the patient and/or family. The law further includes requirements for the notification and apology to be done in person and followed up in writing, and for support to be provided to patients and/or family as they deal with the repercussions of the error. Medical providers are also required to inform the patient and/or family of any follow-up to the situation, such as new information about the patient's condition and steps being taken to prevent the same or a similar error in the future. The law also requires that support be provided to the medical personnel involved in the error, since they may suffer guilt, anxiety, and other stress as a result of their mistake. Such mistakes might include providing the wrong treatment, providing the right treatment in an incorrect manner, omitting a treatment, or misdiagnosing a condition.
Duty of candour requires this process to be initiated when a patient dies because of a medical mistake. The candour law also apply if the patient suffers severe and permanent harm or serious temporary medical or psychological injury due to an error. It applies whether the harm becomes apparent during an active procedure or care, following discharge from care, or after the patient's death.
The law allows for hospitals and medical providers to establish their own policies and designate their own personnel to handle the notifications and apologies. It sets out the requirements for what needs to be disclosed and specifies that concern about future lawsuits cannot be considered in sharing the information. The process of admitting mistakes and apologizing for them does not protect medical professionals from being held accountable for their errors.
Proponents of duty of candour hoped it would encourage providers to be more careful and deliberate in providing care. They also hoped that a requirement for providers to report errors would help bring mistakes to light faster and prevent deaths and/or injuries that might result because someone did not want a mistake to be known. However, some doctors and other medical personnel have pointed out that their own professional associations have recommended such candour since the 1950s and that the majority of health care workers already comply with such policies voluntarily. They question the necessity of the law and its potential to create unrealistic expectations among patients who may not understand what types of incidents triggered the law's provisions.
Bibliography
Devlin, Michael. "Why the New Duty of Candour Could Be Detrimental to the NHS." Guardian, 8 Apr. 2014, www.theguardian.com/healthcare-network/2014/apr/08/duty-of-candour-nhs. Accessed 11 Nov. 2017.
"Duty of Candour." Action against Medical Accidents, www.avma.org.uk/policy-campaigns/duty-of-candour/. Accessed 11 Nov. 2017.
"Duty of Candour." Royal College of Nursing, www.rcn.org.uk/get-help/rcn-advice/duty-of-candour. Accessed 11 Nov. 2017.
"Duty of Candour—Introduction." National Health Service Litigation Authority, www.nhsla.com/OtherServices/Documents/NHS%20LA%20-%20Duty%20of%20Candour%202014%20-%20Slides.pdf. Accessed 11 Nov. 2017.
"Duty of Candour Quick Guide." Medical Defense Union, 13 Oct. 2017, www.themdu.com/guidance-and-advice/guides/duty-of-candour. Accessed 11 Nov. 2017.
Laurence, Jeremy. "Doctors' Basic Errors Are Killing 1,000 Patients a Month." Independent, 13 July 2012, www.independent.co.uk/life-style/health-and-families/health-news/doctors-basic-errors-are-killing-1000-patients-a-month-7939674.html. Accessed 11 Nov. 2017.
"Robbie Powell: CPS to Review Schoolboy's Death 24 Years Ago." BBC News, 4 Nov. 2014, www.bbc.com/news/uk-wales-29898601. Accessed 11 Nov. 2017.
"Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S." Johns Hopkins Medicine, 3 May 2016, www.hopkinsmedicine.org/news/media/releases/study‗suggests‗medical‗errors‗now‗third‗leading‗cause‗of‗death‗in‗the‗us. Accessed 11 Nov. 2017.