The accounting firm of PricewaterhouseCoopers issued a public apology for the errors that led to the mistaken announcement of “La La Land,” rather than “Moonlight,” as the winner of this year’s best-picture Oscar. “We are currently investigating how this could have happened, and deeply regret that this occurred,” the firm said in a statement.

Delivering the wrong Oscar envelope is a far cry from delivering the wrong medication to a patient. The Academy Awards oops led to some awkward moments watched by millions worldwide, but no one was injured. That is not always the case when things go wrong in medicine. The AMA Code of Medical Ethics has guidance for physicians on the proper handling of medical errors.

What the Code says

In Opinion 8.6, “Promoting Patient Safety,” the Code explains:

In the context of health care, an error is an unintended act or omission or a flawed system or plan that harms or has the potential to harm a patient. Patients have a right to know their past and present medical status, including conditions that may have resulted from medical error. Open communication is fundamental to the trust that underlies the patient-physician relationship, and physicians have an obligation to deal honestly with patients at all times, in addition to their obligation to promote patient welfare and safety. Concern regarding legal liability should not affect the physician’s honesty with the patient.

Even when new information regarding the medical error will not alter the patient’s medical treatment or therapeutic options, individual physicians who have been involved in a (possible) medical error should:

(a) Disclose the occurrence of the error, explain the nature of the (potential) harm, and provide the information needed to enable the patient to make informed decisions about future medical care.

(b) Acknowledge the error and express professional and compassionate concern toward patients who have been harmed in the context of health care.

(c) Explain efforts that are being taken to prevent similar occurrences in the future.

(d) Provide for continuity of care to patients who have been harmed during the course of care, including facilitating transfer of care when a patient has lost trust in the physician.

Physicians who have discerned that another health care professional (may have) erred in caring for a patient should:

(e) Encourage the individual to disclose.

(f) Report impaired or incompetent colleagues in keeping with ethics guidance.

As professionals uniquely positioned to have a comprehensive view of the care patients receive, physicians must strive to ensure patient safety and should play a central role in identifying, reducing and preventing medical errors. Both as individuals and collectively as a profession, physicians should:

(g) Support a positive culture of patient safety, including compassion for peers who have been involved in a medical error.

(h) Enhance patient safety by studying the circumstances surrounding medical error. A legally protected review process is essential for reducing health care errors and preventing patient harm.

(i) Establish and participate fully in effective, confidential, protected mechanisms for reporting medical errors.

(j) Participate in developing means for objective review and analysis of medical errors.

(k) Ensure that investigation of root causes and analysis of error leads to measures to prevent future occurrences and that these measures are conveyed to relevant stakeholders.

AMA Principles of Medical Ethics: I,II,III,IV,VIII

More go-to guidance

Chapter 8 of the Code,Opinions on Physicians & the Health of the Community,” also features opinions on the use of quarantine, disparities in health care, routine universal immunization of physicians, and health promotion and preventive care.

The Code of Medical Ethics is updated periodically to address the changing conditions of medicine. The new edition, adopted in June 2016, is the culmination of an eight-year project to comprehensively review, update and reorganize guidance to ensure that the Code remains timely and easy to use for physicians in teaching and in practice.

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