Communication and Transparency in the Time of COVID-19

By Sam Cox and Evan Benjamin, MD, MS

The COVID-19 pandemic has strained our medical systems, transforming the medical environment for both patients and staff. Medical errors are not uncommon in normal times, but the upended medical environment physicians now find themselves in has in several ways made adverse events even more difficult to avoid. At the same time, patients are approaching the health care system with added fear and uncertainty. Faced with these added challenges, communication and transparency are more important than ever. In cases of medical error, a comprehensive Communication and Resolution Program can help ensure that patients are thoroughly informed.

Physicians and hospitals are facing unprecedented challenges in delivering their usual standard of care. The urgency of handling COVID-19 cases has necessitated the delay of elective procedures, leaving some surgeries to be held up significantly longer than they otherwise would have. The high volume of cases has exceeded the capacity of many facilities, leading to shortages of equipment such as beds and ventilators, and in some places leading to the rationing of care. There have been shortages of personal protective equipment, forcing doctors to wear inadequate equipment or to use the same masks and gloves between patients. Some doctors have had to shift to work in areas outside of their expertise, participating in procedures with which they might not be comfortable. On top of all this is the fact that COVID-19 is new, and not all best practices are known or established, with new information emerging all the time. This ultimately leaves opportunities for adverse events to occur despite the best effort of all parties.

These disruptions from COVID-19 are also affecting hospital inpatients in emotional and psychological ways. Patients are generally aware of the havoc COVID-19 has wreaked on the medical system, causing many to be fearful about coming to hospitals themselves. The fear of contracting COVID-19, as well as the knowledge of the difficulties providers are facing, are likely to increase patients’ anxiety throughout the duration of their hospital stay. Additionally, physicians may not spend as much time with patients under contact isolation, potentially hampering care and relationship-building between the provider and the patient. Many facilities are restricting visitors, isolating hospitalized patients even more than usual and creating communication challenges between patients and their families and friends. Patients are thus left in a position where they are likely to have a heightened sense of fear and uncertainty as well as an increased feeling of isolation from their physician and the outside world.

It is understandable that all of these factors together could make both patients and doctors more concerned about health care practice and communication. Patients might obviously be concerned about the dangers to their own health, but many doctors are facing increased concerns about potential liability. With so much uncertainty, shortages, overwork, unfamiliar workspaces, and the danger of transmission within the hospital, it has become increasingly difficult for physicians to consistently meet traditional standards of care. Liability fears are not entirely unfounded — one law firm seemed to encourage lawsuits on its website, posting that some providers were using “untested treatment plans” or “hastily-designed and manufactured patient care equipment” that might lead to malpractice. Some hospital groups have pushed for blanket immunity to address these concerns, while patient advocates have argued that this measure could strip patients of essential protections.

So how can this situation be remedied? There is no perfect prescription for what exactly should be done, but to successfully address the emerging challenges, the solution should focus on transparency and communication. It is more important than ever that medical staff maintain timely and effective communication with the patient and family, both throughout and after the medical episode. A fundamental level of transparency must be maintained with the patient, ensuring they are well informed about all treatment plans and options, as well as the risks or benefits that come along with them. Finally, if and when there is an unexpected outcome or an adverse event, open communication, transparency, and a frank discussion about resolution will help to maintain trust in the system and may avoid lawsuits, all the while allowing patients to get what they truly desire: honesty, compassion, an apology, and learning.

There is promising evidence supporting these practices in the form of Communication and Resolution Programs, or CRPs. CRPs are comprehensive programs that promote transparency, ensuring that patients are thoroughly informed throughout their interactions with the medical system, and that they are proactively offered fair compensation for any potential adverse events. CRPs have been demonstrated to decrease the rate of new malpractice claims and decrease legal costs, while showing no negative effect on liability. Engaging openly with the patient and discussing adverse events with them could also boost a facility’s ability to improve, which is particularly important for learning the best way to manage patients with COVID-19 infections. Perhaps most importantly, the empathetic and transparent communication facilitated by CRPs can improve patients’ satisfaction, and can have long-term emotional benefits, decrease health care avoidance and help retain patient trust in the health system.

If physicians provide clear explanations and take responsibility early, and hospitals thoroughly investigate case specifics, physicians and patients will be able to build more positive and trusting relationships. With the amount of anxiety and confusion surrounding COVID-19 prevention and treatment, there is no better time for such practices to be implemented.

Evan M. Benjamin, MD, MS, is the chief medical officer at Ariadne Labs and Associate Professor at Harvard Medical School. This blog was co-written by Sam Cox, an intern for the Office of the CMO at Ariadne Labs.

Illustration by Kateryna Kovarzh / iStock

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