A 75-year-old man is hospitalized with a severe pneumococcal pneumonia. After 48 hours of hospitalization, he begins to recover. On the 3rd day of hospitalization, he suddenly develops chest pain while being prepared for discharge. An emergency CT reveals a pulmonary embolus. After reviewing the patient's chart, it becomes apparent that although he had no contraindications, he was not placed on anticoagulant thromboprophylaxis. The patient's wife arrives and asks if this complication could have been prevented. Which of the following is the best response to her question?

Question

A 75-year-old man is hospitalized with a severe pneumococcal pneumonia.  After 48 hours of hospitalization, he begins to recover.  On the 3rd day of hospitalization, he suddenly develops chest pain while being prepared for discharge.  An emergency CT reveals a pulmonary embolus.  After reviewing the patient's chart, it becomes apparent that although he had no contraindications, he was not placed on anticoagulant thromboprophylaxis.  The patient's wife arrives and asks if this complication could have been prevented.  Which of the following is the best response to her question?

Quizplus · Accepted Answer

Explanation: Errors are an unfortunate reality of patient care, especially as the practice of medicine grows more complex. Physicians are ethically obligated to disclose medical errors to patients and family. A forthright apology and explanation of the medical facts contribute to building trust and strengthening the physician-patient relationship. Research has shown that when medical errors are made, patients and their families primarily care about receiving an explanation and an apology from the responsible physician(s) early in the process. Prompt disclosure actually decreases malpractice risk, as litigation is more often pursued when the patient and family feel deceived or avoided. Therefore, this patient and his wife should be informed that prophylaxis decreases the risk of thrombosis and that it was mistakenly not given. (Choices A, C, and E) Although there is no way to prevent all potential complications of pneumonia and thrombosis can occur with or without prophylactic treatment, these statements do not acknowledge that the patient's thrombotic event may be the result of a medical mistake. Research has shown that the risk of venous thromboembolism is reduced in patients who receive prophylaxis. (Choice B) This statement is inaccurate as prophylaxis decreases the risk but cannot prevent thrombosis. Educational objective: Physicians are obligated to inform patients and family of medical errors. Timely disclosure accompanied by an empathic apology and explanation will help to preserve the physician-patient relationship. References: Teaching medical error disclosure to residents using patient-centered simulation training. (http://www.ncbi.nlm.nih.gov/pubmed/24280843) Disclosing medical errors: the view from the USA. (http://www.ncbi.nlm.nih.gov/pubmed/24461211)

A 75-Year-Old Man Is Hospitalized with a Severe Pneumococcal Pneumonia