Mutual Matters

Complicated Communication: Discussing Unexpected Outcomes 

Posted by Marshaleen King, MD on Feb 8, 2018 12:05:00 PM

P_FemaleDoctorPatient.jpgCase Scenario

A 32-year-old woman underwent emergency cesarean section due to fetal bradycardia. Her C-section was complicated by an injury to her bladder which was repaired immediately by her obstetrician. Post-operatively, the patient was not informed of this complication as the obstetrician reasoned that this was included as a possible complication on the consent form. In addition, the obstetrician was of the opinion that the bladder repair was successful thus the patient was unlikely to experience any future problems related to this complication.

Ten days following delivery the patient presented to her primary care physician complaining that an increasing amount of fluid was draining continuously from her vagina. The patient’s primary care physician examined her and reviewed the records that had been faxed over by the obstetrician following her delivery. The discharge summary included documentation of the patient’s bladder injury and the fact that it was repaired. The primary care physician then explained to the patient that the fluid leaking from her vagina was likely due to a vesico-vaginal fistula that developed as a result of her bladder injury. To the primary care physician’s surprise, the patient had no knowledge that a bladder injury occurred during her C-section. The patient was very upset that her obstetrician failed to inform her of this complication and the possible sequalae. Following her discussion with her primary care physician, she promptly called her obstetrician’s office to voice her displeasure.

Discussion

Failure to disclose a complication not only breaches the code of professional ethics, but also destroys the trust in the physician-patient relationship and exposes physicians to an increased risk of litigation should the complication be discovered by the patient at a later point. Although many physicians fear that patients will become angry and sue once a complication is disclosed, honest communication about complications has been shown to avert anger and litigation. Communicating honestly with patients preserves the trust in the physician-patient relationship and enables patients to maintain a level of respect for their physician.

Find out what steps we recommend for communicating after unexpected outcomes or complications by clicking below. 

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Topics: Patient Care and Interaction

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