For surgeons, complications and adverse patient events can raise questions that extend well beyond how to manage the clinical consequences. When a patient has been harmed, what should the surgeon tell them? How much should they explain about why the event occurred? And what responsibilities remain after that initial conversation?
Thomas H. Gallagher, MD, has spent more than 25 years examining these questions and how clinicians and healthcare organizations can better respond when patients experience harm.
“Clinicians come hardwired with this set of reflexes that oftentimes don't serve us particularly well. When things go wrong in medicine, as physicians, we oftentimes don't know how to respond,” Dr. Gallagher said.
He will explore these difficult decisions during today’s John J. Conley Ethics and Philosophy Lecture, “Responding to Patients Who Have Been Harmed by Their Healthcare: Implementing the Modern Ethical Paradigm,” at 9:45 am in Room 140AB.
Dr. Gallagher, a general internist at University of Washington Medicine in Seattle and a research professor at the Johns Hopkins Berman Institute of Bioethics in Baltimore, Maryland, focuses his research on the intersection of healthcare quality, communication, and transparency. He is an expert in implementing Communication and Resolution Programs (CRPs) for responding to healthcare harm.
The subject is one that can become deeply personal for surgeons whose work inherently involves causing controlled injury in pursuit of healing.
“Everyone recognizes that sort of pit-in-your-stomach feeling when you're involved in something that's gone wrong,” Dr. Gallagher said, describing the questions clinicians may immediately ask themselves about what happened and what they need to disclose.
To make those questions tangible, Dr. Gallagher said he will begin the lecture by examining a hypothetical case in which a laparoscopic cholecystectomy leads to a common bile duct injury. In the scenario, a surgeon uses an unfamiliar dissection and coagulation device that inadvertently burns the common bile duct, requiring conversion to an open procedure and repair.
The injury is a known potential complication of the operation, but in this case, it resulted from an error involving the use of the device.
The scenario raises a critical distinction: It is one thing to tell the patient that an injury occurred, but another entirely to explain why.
“Where the surgeons really differ is, should we tell the patient the injury occurred due to a technical error in the way I was using this new device?” Dr. Gallagher said. The case will serve as a starting point for examining broader ethical questions surrounding patient harm.
Those questions include how much information patients should receive, how long clinicians’ obligations to injured patients continue, and how healthcare organizations should navigate information uncovered through legally protected reviews of adverse events.
Dr. Gallagher also will discuss CRPs, structured approaches designed to help clinicians and organizations respond to harm in a principled and systematic way.
For Dr. Gallagher, the goal is to identify an approach that serves everyone affected by these difficult events.
“How can we respond when something has gone wrong in healthcare in a way that is aligned with our professional and ethical values, in a way that supports the needs of patients and families, in a way that supports the needs of clinicians, and in ways that reduces our likelihood of being sued for malpractice?” he said.
Ultimately, the lecture will offer surgeons a framework for confronting situations in which clinical judgment, transparency, accountability, and professional responsibility intersect.
“We’re going to walk through a series of these challenging ethical issues related to the response to harm and try to think together about the principles that can help a surgeon faced with a dilemma like that respond in a way that is consistent with the highest standards,” Dr. Gallagher said.
