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Open disclosure

24 July 2015

Transparent and open healthcare is not something for doctors to fear, it is actually a golden opportunity to build trust in the doctor-patient relationship.

Most healthcare professionals would agree with the concept of openness – but differences arise from country to country, and from organisation to organisation, on how to achieve it. In many jurisdictions around the world, it is a regulatory, rather than a statutory, duty to be open with patients following an adverse incident.

The Medical Council of Hong Kong is not explicit about being open, but advises doctors: “Good communication between doctors and patients, and between doctors, is fundamental to the provision of good patient care.”

Many doctors already worry about the legal and professional consequences of making a mistake – and fear of legal sanction could prove counter-productive, forcing the reporting of mistakes underground.

What do patients want?

Patients want doctors to be honest and sincere. Just saying ‘sorry’ after an avoidable adverse event isn’t enough – information about what happened and how it came to happen needs to be provided openly and empathically. In addition, the patient will want to know what you have learned from what happened to them, and what you have changed in order to reduce the chance of it happening again to another patient.

Admitting mistakes is morally and ethically the right thing to do – and evidence does suggest that this is all that patients want when they complain: to understand what happened and why. However, for many doctors there remains a barrier to open disclosure – a barrier of fear.

Fear factor

Doctors often fear saying sorry or admitting responsibility when reporting incidents. A positive doctor–patient relationship might lessen the fear factor. By being open, you do not have to admit guilt or liability, blame others, or speculate: an apology is not equivalent to an admission of liability.

Changing a doctor’s reaction to adverse events from fear into an eagerness to report, explain and learn from what went wrong is something that can only happen through cultural osmosis. Meaningful open disclosures that patients expect are more likely to be delivered by doctors committed to transparent working at all levels, rather than doctors forced to report adverse incidents through legislation and a “top down” managerial approach.

The best way to prevent a smokescreen surrounding adverse incidents and encourage open disclosure, whether by statutory duty or a culture of change, is something that will continue to be hotly debated.

Dr Ming-Keng Teoh, Head of Medical Services for Asia at MPS, believes that when things go wrong the misplaced fear of doctors stops them from being open and showing how caring and professional they are.

“Instead, being defensive and not providing information often leads to more suspicion and resentment from patients and their families. A golden opportunity to build trust, respect and a healthy doctor-patient relationship is sadly wasted,” he said.

“Doctors must recognise that the darkest hours when patients are coping with disappointment and despair from bad outcomes are the times when they need their doctors most. We need to be there for them to show care and to explain matters fully so that it makes sense to them why there was a bad outcome.”

Culture of candour

MPS has long promoted a culture of candour in all countries it serves, with efforts focused on fostering a culture of openness and trust that is lacking within some healthcare organisations. This is not only part of good medical practice but will also reduce the likelihood of complaints and claims when things go wrong.

A culture of candour can be achieved by mentoring, training and supporting staff to communicate effectively and sensitively with patients when things go wrong and ensuring senior clinicians lead by example.


1. Medical Council of Hong Kong, Code of Professional Conduct (2009)