No abstract available.
Disclosure

No abstract available.
Disclosure

Patient safety and medical errors have emerged as global concerns and error disclosure has been established as standards of practice in many countries. Disclosure of medical errors to patients and their families is an important part of patient-centred medical care and is essential to maintaining trust. However, physicians still hesitate to disclose errors to patients despite their belief that errors should be disclosed. Multiple barriers such as fear of medical lawsuits and punishment, fear of damaging their professional reputation, and diminished patient trust inhibit error disclosure. These barriers as well as lack of training or education programs addressing error disclosure contribute to a low estimated disclosure rate in real situations. Nowadays, the importance of patient safety education including error disclosure is emphasized and related research is increasing. In this paper, we will discuss the background of medical error disclosure and studies on education programs related to error disclosure. In this regard, we will examine the content and methods currently being taught, discuss the effects or outcomes of such education programs and obstacles or difficulties in implementing them. Finally, the direction of future error disclosure education, support systems, and education strategies will also be covered.
Disclosure ; Education ; Education, Medical ; Humans ; Medical Errors ; Patient Safety ; Punishment ; Truth Disclosure

Magandang Gabi po sa inyong lahat lalo na sa mga bagong specialista (o Diplomate) ng ating samahang PBO-HNS na pinararangalan natin ngayon; Ganuon din sa kanilang mga kabiyak, at mga magulang, mga marangal nating panauhin at syempre sa mga dati kong kasama sa PSO at PBO-HNS. Itong samahang ito ang hindi tumitigil na paunlarin ang mga patakaran ng Society at para ang ENT Diplomate ay maging tunay na specialist at hindi “ispecialista daw.” For the single ones among you, let’s give your parents special citation for having sacrificed not only once during your medical student days but twice-during your residency days. Their encouragement and material aid are phenomenal. Likewise to those married, your spouses either had a more challenging housewife’s role or became “house bands” during your busy training days. So in this talk of mine which you may consider “unsolicited advice,” I will mention some idealistic-- even bordering on the philosophical -- reminders of some of our pillars in the specialty and my own experience as a budding practitioner. Also my personal pitfalls and how to possibly solve them. After all, when we reach our sunset years, we can discuss such topics ad infinitum.
Empathy ; Disclosure

Breaking bad news to patients is one of the most difficult communication tasks to clinicians. The quality of delivery of bad news seems to be directly related to patients' anxiety and distress, strong emotions, their adjustments to bad situation, coping and satisfaction with care and clinical outcomes. Evidence has supported that health care professions' communication skills to deliver bad news can be improved by communication skills education and training. In this review, the author described the definition of bad news, patients' preferences and views on communication of bad news, some protocols or guidelines to breaking bad news, and educational effect of bad news communication skills training. In addition, the author suggested some practical tips and dialogue examples in Korean, which can be applied into clinical settings.
Anxiety ; Delivery of Health Care ; Education ; Health Communication ; Humans ; Physician-Patient Relations ; Truth Disclosure

Diabetes mellitus is an 'insulin problem' as the maintenance of normoglycaemia is affected by either reduced pancreatic insulin production or cellular insulin resistance. During a patient's first visit for type 2 diabetes mellitus, there are several consultation tasks that the doctor should consider. First, the doctor has to disclose the diagnosis. Second, there is a need to correct any myths and misconceptions that the patient may have on the disease. Next, to allow the doctor to provide patient-specific disease education and advice on lifestyle modifications and goal setting, the biopsychosocial impact of the disease on the patient should be assessed, and relevant lifestyle information gathered. Lastly, screening for the complications of diabetes mellitus and its associated medical conditions should be planned.
Diabetes Mellitus, Type 2 ; diagnosis ; prevention & control ; Humans ; Life Style ; Patient Care Planning ; organization & administration ; Physician-Patient Relations ; Truth Disclosure

This paper reviewed structure and current status of laws related to patient safety using patient safety law matrix to promote systematic approach in legal system of patient safety. Laws related to patient safety can be divided into three areas: laws for preventing; laws for knowing about; and laws for responding. In the case of Korea, gaps are especially prominent in the areas of laws for knowing about and responding. Patient safety law which will be enacted in July 2016 will fill the gap in the area of laws for knowing about. This law will be comprehensive law, covering the full spectrum of laws related to patient safety. However, after reviewing current patient safety law in Korea, the following drawbacks were identified: absence of code for grasping the current patient safety level; absence of code for mandatory reporting in patient safety reporting system; and absence of code for privilege about patient safety work product. Furthermore we need wider discussions about covering issues of open disclosure, apology law, coroners system, and complaint management system in patient safety law.
Coroners and Medical Examiners ; Disclosure ; Hand Strength ; Humans ; Jurisprudence ; Korea* ; Mandatory Reporting ; Patient Safety* ; Risk Management

Non-disclosure in Paediatric Practice is a controversial issue. There was a time when the care of children was solely the responsibility of parents and any decision with respect to treatment or non-treatment would have been the joint responsibility of the parents and of the attending medical professionals. This practice, viewed as adopting a more paternalistic approach, has been challenged in many parts of the world. In essence what is being challenged is the notion that the sole responsibility of decision-making rests with parents.
Clinical Competence ; Communication ; Decision Making ; Ethics, Medical ; Humans ; Parent-Child Relations ; Patient Rights ; ethics ; Pediatrics ; ethics ; Physician-Patient Relations ; ethics ; Practice Patterns, Physicians' ; Truth Disclosure ; ethics

Hope is essential in the face of terminal cancer. Generally in Western societies, patients and their families prefer their doctor to engage them in transparent, realistic, authoritative, empathic and open communication about the diagnosis and prognosis of cancer but this topic is not well studied in the Asian context. With the exponential increase in information about cancer and the many permutations in cancer treatment, rational and otherwise, the doctor-patient relationship is even more critical in planning the best treatment strategy and also in rendering both particular and general hope in the patient's war against cancer. Overall, the majority of drugs tested against cancer have failed to reach the market, and those that have, only provide modest benefits, several major therapeutic breakthroughs notwithstanding. Commoditised medicalisation of the dying process ingrained into the contemporary consciousness can potentially create unrealistic or false hope, therapeutic nihilism and a drain on the resources of both the patient and society. These factors can also detract from the dignity of dying as an acceptable natural process. Hope cannot be confined only to focusing merely on the existential dimension of improving survival through technological intervention. Psychosocial and, where appropriate, spiritual interventions and support also play major roles in relieving suffering and providing hope to the patient. Hope cannot be a victim of misinformation from self-interested external parties, nor be an obsession with just buying promises of extending survival time without sufficient regard for quality of life and achieving a good death.
Attitude to Death ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Physician-Patient Relations ; ethics ; Prognosis ; Spirituality ; Terminal Care ; ethics ; methods ; psychology ; Truth Disclosure ; ethics

INTRODUCTIONThe traditional family-centred approach to cancer management in Singapore often leads to nondisclosure of diagnosis to patients with advanced cancer. This study aimed to determine the rate of nondisclosure to such patients in Singapore, and compare it against the rate of nondisclosure to patients' families and that of a study conducted in 1992.

METHODSConsecutive patients (n = 100) with advanced cancer who were referred to a palliative home care service in 2004 were studied retrospectively. Comparison between the 1992 and present study groups was performed using chi-square and Fisher's exact tests. Multivariate logistic regression was applied to patient age, Eastern Cooperative Oncology Group (ECOG) performance status, gender and ethnicity to identify factors associated with nondisclosure.

RESULTSThe overall nondisclosure rate among patients with advanced cancer was 23% (23/100), compared to only 2% (2/99) among their families (p < 0.001). The nondisclosure rates among ECOG 0-2 and ECOG 3-4 patients were 11% (7/62) and 42% (16/38), respectively (p < 0.001). There was no significant improvement in the nondisclosure rate among ECOG 3-4 patients when compared to the 1992 study (p = 0.94). It was more likely for nondisclosure to occur among patients aged ≥ 70 years (p < 0.001; odds ratio [OR] 14.77, 95% confidence interval [CI] 3.68-59.26) and those with poor ECOG performance status (p = 0.019; OR 4.0, 95% CI 1.26-12.73). There was no significant association between nondisclosure and gender or ethnicity (p > 0.05).

CONCLUSIONDisclosure of diagnosis to patients with advanced cancer remains a challenge in Singapore. The relationship between nondisclosure and advanced age, as well as nondisclosure and poor ECOG performance status, needs to be clarified with further studies.

Age Factors ; Aged ; Cohort Studies ; Female ; Humans ; Male ; Medical Oncology ; methods ; Middle Aged ; Neoplasms ; diagnosis ; Palliative Care ; methods ; Professional-Patient Relations ; Regression Analysis ; Retrospective Studies ; Singapore ; Truth Disclosure