How Communication "Failed" or "Saved the Day": Counterfactual Accounts of Medical Errors

Richard L Street Jr; John V Petrocelli; Azraa Amroze; Corinna Bergelt; Margaret Murphy; J Michael Wieting; Kathleen M Mazor

doi:10.1177/2374373520925270

How Communication "Failed" or "Saved the Day": Counterfactual Accounts of Medical Errors

J Patient Exp. 2020 Dec;7(6):1247-1254. doi: 10.1177/2374373520925270. Epub 2020 May 26.

Authors

Richard L Street Jr^{1

2}, John V Petrocelli³, Azraa Amroze⁴, Corinna Bergelt⁵, Margaret Murphy⁶, J Michael Wieting⁷, Kathleen M Mazor⁴

Affiliations

¹ Department of Communication, Texas A&M University, College Station, TX, USA.
² Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
³ Department of Psychology, Wake Forest University, Winston-Salem, NC, USA.
⁴ Meyers Primary Care Institute, a Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, MA, USA.
⁵ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶ Patients for Patient Safety (PFPS), WHO Patients for Patient Safety, Ireland.
⁷ DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA.

Abstract

Communication breakdowns among clinicians, patients, and family members can lead to medical errors, yet effective communication may prevent such mistakes. This investigation examined patients' and family members' experiences where they believed communication failures contributed to medical errors or where effective communication prevented a medical error ("close calls"). The study conducted a thematic analysis of open-ended responses to an online survey of patients' and family members' past experiences with medical errors or close calls. Of the 93 respondents, 56 (60%) provided stories of medical errors, and the remaining described close calls. Two predominant themes emerged in medical error stories that were attributed to health care providers-information inadequacy (eg, delayed, inaccurate) and not listening to or being dismissive of a patient's or family member's concerns. In stories of close calls, a patient's or family member's proactive communication (eg, being assertive, persistent) most often "saved the day." The findings highlight the importance of encouraging active patient/family involvement in a patient's medical care to prevent errors and of improving systems to provide meaningful information in a timely manner.

Keywords: patient activation; patient engagement; patient safety; physician–patient communication; physician–patient relations.