1. The obligation to disclose
2. The impediments to effective disclosure
3. The advantages of effective disclosure
4. The kinds of situations in which disclosure is essential
5. The CONES strategy and its application to effective disclosure

We have an ethical (and regulatory) obligation to disclose adverse events.

Three major impediments to effective disclosure

1. Concern over potential liability
2. Lack of appropriate institutional resources and mechanisms
3. Lack of interpersonal communication skills needed for effective disclosure

Worthwhile doing a good job

• Patient and/or family feel better if some kind of resolution is acheived
• You feel better and more competent
• Considerable time and money is saved

When do you have to tell?

1. Sudden marked deterioration in patient condition
2. Adverse event (e.g., drug reaction)
3. Medical error
4. Death of patient

How to tell: the CONES strategy

• privacy
• sitting down
• body language
• eye contact
• hand shake

• Set agenda up front
• "I'd like to talk to you about... "

• Explain events in chronological order
• Include details of thinking and uncertainties at each stage

• Address and acknowledge the emotions that arise during the conversation

• Plan for next few hours or days
• Clear contract for next contact

How to Deal with Anger & Other Emotions in Adverse Event & Error Disclosure. Robert Buckman MD

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