Information Statement

Communicating Adverse Events or Poor Outcomes

This Information Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

Adverse events or poor outcomes are inevitable in the practice of medicine. Frank discussion and honest communication about the event between the physician and the patient/family are imperative. An adverse or poor outcome does not necessarily result from an error or negligent care, but may be from a combination of factors, including complications, diverse biological interactions, or unrealistic expectations regarding treatment benefits versus potential risks.

Consistent with Joint Commission standards and the American Academy of Orthopaedic Surgeon’s Principles of Medical Ethics and Professionalism, the AAOS believes that an orthopaedic surgeon should put the interests of the patient first and communicate directly with a patient/family member in an honest, compassionate manner as soon as possible after an adverse event or poor outcome occurs.

As stated in the AAOS Information Statement on The Importance of Good Communication in the Physician-Patient Relationship, good communication with patients has always been essential in orthopaedic practice and is the cornerstone of the physician – patient relationship. Open, honest communication favorably affects patient behavior, health outcomes, patient satisfaction, and often reduces the incidence of medical professional liability actions.

When an adverse event or poor outcome occurs, the orthopaedic surgeon should first address the patient's immediate health care needs and then institute an investigation to collect all pertinent information. The orthopaedic surgeon should discuss the event honestly and empathetically with the patient and/or family with disclosure of known facts and an explanation offered as to the likely cause. This disclosure conversation should also include a discussion of ongoing treatment, follow up care, and prognosis.

If the adverse outcome or poor outcome is the result of a medical error, the orthopaedic surgeon has an ethical and professional obligation to disclose the error to the patient and/or family. This disclosure conversation should include what happened, why it happened, health implications for the patient, and what measures are being instituted to prevent recurrences. Many patients have expressed that an apology is important. The physician should support the patient and family, show compassion and concern, and acknowledge their emotional response and needs during this difficult time. This will help to set clear goals for the future patient-physician interaction.

The physician-patient relationship is built upon trust and honesty. The AAOS Code of Medical Ethics and Professionalism reinforces these principles in section II.A. which states: “The orthopaedic surgeon should maintain a reputation for truth and honesty. In all professional conduct, the orthopaedic surgeon is expected to provide competent and compassionate patient care, exercise appropriate respect for other health care professionals, and maintain the patient’s best interests as paramount.” Consistent with these principles, the AAOS urges orthopaedic surgeons to behave in a manner consistent with these recommendations when communicating about adverse events or poor outcomes with their patients and their family members.

October 2004 American Academy of Orthopaedic Surgeons.
Revised June 2011.

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.

Information Statement 1028

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