The Essentials of Patient Safety - Clinical Human Factors Group

The Essentials of Patient Safety
CHAPTER 6
The Aftermath
Many patients experience errors during their treatment, whether they realise it or not, and
some are harmed by healthcare. The harm may be minor, involving only inconvenience
or discomfort, but can involve serious disability or death. Almost all bad outcomes will
have some psychological consequences for both patients and staff, ranging from minor
worry and distress through to depression and even despair. The experiences of these
people tend not to be fully appreciated, and yet understanding the impact of such
injuries is a prerequisite of providing useful and effective help.
Injury from medical treatment is different from other injuries
Patients and relatives may suffer in two distinct ways from a medical induced injury.
First from the injury itself and secondly from the way the incident is handled afterwards.
Many people harmed by their treatment suffer further trauma through the incident being
insensitively and incompetently handled. Conversely when staff come forward,
acknowledge the damage, and take positive action the support offered can ameliorate the
impact both in the short and long term. Injured patients need an explanation, an apology,
to know that changes have been made to prevent future incidents, and often also need
practical and financial help (1). The problems arise when ordinary impulses to help are
blunted by anxiety, shame or just not knowing what to say.
The emotional impact is particularly complex because a medical injury differs
from most other accidents in some important respects. First, patients have been harmed,
unintentionally, by people in whom they placed considerable trust, and so their reaction
may be especially powerful and hard to cope with. Imagine the complex of emotions
you might experience if you were accidentally injured by a member of your own family.
Secondly they are often cared for by the same professions, and perhaps the same people,
as those involved in the original injury. As they may have been very frightened by what
has happened to them, and have a range of conflicting feelings about those involved.
This too can be very difficult, even when staff are sympathetic and supportive.
The full impact of some incidents only becomes apparent in the longer term. A
perforated bowel, for example, may require a series of further operations and time in
hospital. As with all injuries the effects and associated problems can multiply over time,
especially if recovery is only partial. Chronic pain for in
mood, ability to care for their children ability to work, their family and social
relationships and their sexual relationship.
As relationships deteriorate, the person may become more isolated, less engaged
and consequently more prone to depression; this in turn makes work, family life and
child
care more difficult (2). The whole scenario may be compounded by the financial
problems induced by not being able to work, and the anxiety about the future that this
causes. Most of this is unseen by the healthcare organisation which caused the injury in
the first place (3).
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