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Found 212 results
  1. News Article
    NHS staff have voiced concern about the growing numbers of patients who are filming themselves undergoing medical treatment and uploading it to TikTok and Instagram. Radiographers, who take X-rays and scans, fear the trend could compromise the privacy of other patients being treated nearby and lead to staff having their work discussed online. The Society of Radiographers (SoR) has gone public with its unease after a spate of incidents in which patients, or someone with them in the hospital, began filming their care. On one occasion a radiology department assistant from the south coast was inserting a cannula into a patient who had cancer when their 19-year-old daughter began filming. “She wanted to record the cannulation because she thought it would be entertaining on social media. But she didn’t ask permission,” the staff member said. “I spent the weekend afterwards worrying: did I do my job properly? I know I did, but no one’s perfect all the time and this was recorded. I don’t think I slept for the whole weekend.” They were also concerned that a patient in the next bay was giving consent for a colonoscopy – an invasive diagnostic test – at the same time as the daughter was filming her mother close by. “That could all have been recorded on the film, including names and dates of birth,” they said. Ashley d’Aquino, a therapeutic radiographer in London, said a colleague had agreed to take photographs for a patient, “but when the patient handed over her phone the member of staff saw that the patient had also been covertly recording her, to publish on her cancer blog. “As NHS staff we wear name badges, so our names will be visible in any video. It makes people feel very uncomfortable and anxious.” Read full story Source: The Guardian, 17 June 2025
  2. Content Article
    In this video, Dr Gail Busby and Dr Andrew Heck discuss the option of sedation for hysteroscopy. Hysteroscopy involves inserting a narrow telescope into the womb (uterus) to see inside. There are several options for pain relief for this procedure. Dr Heck touches on all of the options and discusses sedation in detail. Further reading on the hub: Painful hysteroscopy discussion thread Through the hysteroscope: Reflections of a gynaecologist
  3. News Article
    The National Institutes of Health (NIH) will begin work on a comprehensive federal database of patient records to study autism and chronic disease, Director Jay Bhattacharya announced Monday. The commitment gives legs to Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s calls to find the root cause of childhood autism, which he calls an epidemic. The NIH appears poised to put federal resources to work to create a central, shareable resource for the researchers that undertake RFK Jr.’s call to action. Last week at an event with reporters, Secretary RFK Jr. announced that HHS will soon be offering research grants for identifying the cause of autism, including exploring causes that were formerly considered taboo by the research community. “People will know they can research and follow the science no matter what it says, without any kind of fear that can be censored ... gaslighted ... silenced," he told reporters. The NIH will now work to build out a data resource consisting of medical records, insurance claims and data from wearable devices to aid autism researchers in their quest to find the root cause of the disease. Bhattacharya explained the initiative to a meeting of NIH advisors on Monday. The NIH will partner across the HHS and with external stakeholders. The data sources for the real-world data platform will be pharmacy chains, health organisations, clinical data, claims and billing, environmental, sensors and wearables. The initiative has sparked some privacy concerns from industry groups. "Compiling health and disability-related data from both federal and commercial sources to create a federal registry of people with autism, without individuals’ consent, is the latest dangerous effort by this Administration to repurpose Americans’ sensitive information for unchecked government use," Ariana Aboulafia, project lead of disability rights in technology policy at the Center for Democracy and Technology, said in a statement. "This plan crosses a line in the sand, particularly given longstanding and historical concerns surrounding the creation of registries of people with disabilities. "The data that would be used to create this registry and inform governmental studies on autism was originally shared with government agencies and private companies, like insurers and wearable technology companies, for a wide range of purposes," Aboulafia said. "It’s unclear exactly who the federal government plans to share this data with, or how they’ll eventually use it. And, while NIH has claimed that the confidentiality of this information will be safeguarded using 'state of the art protections,' it’s also unclear if it’ll be anonymized or disaggregated, or how it will be protected from a hack or breach." Read full story Source: Fierce Healthcare, 22 April 2025
  4. News Article
    Almost 1.7 million people have had hernia mesh surgery in the NHS since 2004, figures released by the NHS have revealed. The statistics do not include people who’ve had hernia mesh in private hospitals. Nobody can say how many are now suffering complications – because patients are not tracked for their lifetime. Yet campaigners and academics globally say it can take many years for mesh to cause problems- so the scale of suffering falls into a black hole of missing data. Moreover, support groups show that patients are being implanted with hernia mesh in their thousands ever year – but nobody is being given fully informed consent of the potential risks such as pain, loss of mobility, loss of sex life and losing the ability to have children. Also autoimmune diseases and allergies caused by the plastic mesh material. The figures came to light thanks to a Written Parliamentary Question asked by MP Sharon Hodgson, chair of the All Party Parliamentary Group for First Do No Harm. In its response, The Department of Health say: “Clinicians are expected to inform patients about risks associated with recommended treatments, including reasonable alternatives, to enable informed consent and a balanced patient decision.” But campaign group Sling The Mesh says that the majority of people are told hernia mesh is ‘not the mesh in the media’, or it is a new mesh, or that this is a gold standard treatment and that mesh receives undeserved negative attention. Read full story Source: Sling the Mesh, 25 March 2025
  5. Content Article
    Recent reports have highlighted issues with non-English speaking women and birthing people being able to access equitable maternity care, with inconsistent use of interpreters and translation services, and cases where this has contributed to poor outcomes and avoidable harm. Sands & Tommy’s Joint Policy Unit have produced a briefing paper on translation and interpreting services in maternity and neonatal care. Key messages • Reports and reviews have highlighted issues with the use and quality of interpreting and translation services in maternity care, contributing to poor outcomes and avoidable harm. • Existing guidance states that professional interpreting services must always be available when needed, and that family members should not be used in place of a professional interpreter. • There is poor documentation of interpreting need, and inadequate response to requests for interpretation. • Where interpreting and translation services are available, they are not used consistently. Barriers to this include limited appointment time and poor quality of services. • Lack of high-quality interpreting services are also impacting personalisation of care and choice, and women and birthing people’s ability to give informed consent to treatment and procedures. Follow the link below to read the full briefing paper.
  6. Content Article
    Complete and accurate patient history is essential for patient safety. Medical and surgical information is typically reported by the patient using a checklist to indicate medical and surgical history and current medications and supplements. This method has been shown to be generally successful in obtaining an accurate history in most healthcare settings. However, there are instances when patients may withhold information. Patients may hesitate to disclose information when they fear a procedure may be cancelled, when a topic is sensitive, or when they don’t understand that a particular detail is important to their care. Examples of sensitive topics may include pain management, abortion care, weight loss, gender-affirming care, and medical marijuana use. Recent event reports submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) included patient safety events that involved patients withholding relevant medical information for fear of a procedure being cancelled. Some event reports described patients who underwent a surgical procedure and experienced complications, which necessitated transfer to a higher level of care. After a discussion between the facilities’ patient safety officers and Patient Safety Authority advisors, it was discovered that these patients had a known medical condition but did not disclose this on their medical history form because they were worried that their procedure might be cancelled. In these cases, these preexisting conditions would not have necessitated cancellation, but their course of treatment would have been modified to prevent the complication and, in turn, the transfer to a higher level of care. Other event report submissions describe procedure cancellations due to an active infection, which the patient did not initially disclose to avoid the cancellation. Each case involved sensitive topics and procedures, which may have led to patients withholding information.
  7. Content Article
    When someone needs a joint replacement, there are many factors that affect how well they will respond, how quickly they will recover from the procedure and the potential risks of surgery. Patient complexity is the term used to describe these factors and includes other health conditions, sometimes called co-morbidities, as well as local risk factors related to the specific joint needing to be replaced. In this interview, consultant orthopaedic surgeon Sunny Deo and engineer and founder of TCC-Casemix Matthew Bacon, discuss how new technology is allowing surgeons to more accurately predict the surgical risk and outcomes for patients having knee replacement surgery. They describe how a new approach to data modelling is allowing the orthopaedic team at Great Western Hospital NHS Foundation Trust to more accurately assess complexity for individual patients. This has benefits for patient care and outcomes, theatre productivity and the development of pathways that are more patient-centred. They also highlight some patient safety issues associated with elective surgical hubs, which were set up to deal with high volume low complexity patients, including the deprioritising of more complex patients who may be at greatest need of surgery. Finally, they discuss the applicability of this approach to other specialties and areas of healthcare. Read more about clinical complexity in joint replacement surgery in this presentation by Sunny Presentation - Overview of clinical complexity by Sunny Deo.pdf
  8. Community Post
    *Trigger warning. This post includes personal gynaecological experiences of a traumatic nature. What is your experience of having a hysteroscopy? We would like to hear - good or bad so that we can help campaign for safer, harm free care. You can read Patient Safety Learning's blog about improving hysteroscopy safety here. You'll need to be a hub member to comment below, it's quick and easy to do. You can sign up here.
  9. Content Article
    In this opinion piece for the BMJ, Stephanie O’Donohue explains how a collaborative dialogue between clinician and patient can make a huge difference to patient experiences of gynaecology procedures. With a focus on pain, Stephanie draws on her own experiences, both positive and negative, to illustrate the value of shared-decision making.
  10. News Article
    In 2019, Shahnaz Akhter, a postdoctoral researcher at Warwick University, was chatting to her sister, who mentioned a documentary that had aired on Channel 4 in the mid-1990s. It was about human radiation experiments, including one that had taken place in 1969 in Coventry. As part of an experiment on iron absorption, 21 Indian women had been fed chapatis baked with radioactive isotopes, apparently without their consent. Read full story Source: Guardian, 11 February 2025
  11. Content Article
    This study looked at attitudes towards, and perceptions of, participating in clinical trials among patients with cancer and their relatives. It explored what factors are associated with their willingness or hesitation to engage. The researchers carried out a survey of 978 patients with cancer and their relatives in Turkey. They found that willingness to participate and knowledge about clinical trials were limited and highlight the existence of significant gaps in understanding and persistent concerns about participation.
  12. Content Article
    The following account has been shared with Patient Safety Learning anonymously. We’d like to thank the patient for sharing their experience to help raise awareness of the patient safety issues surrounding IUD procedures. *Trigger warning: Some people may find the following account distressing to read. Please note that experiences of pain and the care given during gynaecological procedures vary greatly. I came across Patient Safety Learning's forum page about IUD experiences after having my first Mirena coil fitting. I felt unable to comprehend the sense of violation and trauma I had just experienced. A suspected cancer referral I was referred by my GP on the 'suspected cancer pathway' for some post menopausal bleeding. On a positive note, I cannot fault the system and the speed with which I was seen, but my treatment during the appointment was so awful I am actually shaking again as I write this. Although this was an urgent referral, I was not particularly anxious as I felt the erratic bleeding I was experiencing was likely due to my hormone replacement therapy (HRT) regime. I was expecting a consultation and a scan, possibly a hysteroscopy; with a change in my HRT regime being the likely outcome. Off to a bad start The appointment started off on the wrong foot with the consultant asking if I thought there was actually any benefit in taking HRT, likening it to long term antidepressant usage. I explained that, as a runner, I was largely taking it for the well researched bone health benefits but I found his question rather belittling with its implied suggestion of menopause being all in the mind. He went on to advise that a Mirena coil would be a better option for me for HRT which I agreed I would consider. He did not explain the procedure or the possible complications or risks. I will add here that I was sterilised at the age of 30 after my second child. Contraception wasn't something I'd had to consider for the past 23 years so it wasn't really something I'd chatted about with friends. I had heard rumours of bad experiences but took it with a pinch of salt - there are after all rumours of bad experiences in all walks of life. I could not have been more wrong. The procedure - I was frozen with shock I stripped to the waist, legs in stirrups and the consultant explained he would first perform a transvaginal ultrasound to check the thickness of the endometrium - this was reassuringly normal. Then without any warning, he told me he was just going to inject some anaesthetic into my cervix and fit a coil. I had no time to prepare myself at all for this - I didn't really feel I had consented but he and both nurses in the room were acting as though this was all very normal. The injections weren't pleasant in themselves, particularly as I wasn't expecting them. There was no pause at all before I felt awful searing pain and pulling sensations, nothing was being explained prior to it being performed. Something was said about my cervix needing to be dilated and it seemed to take forever. I didn't shout out, I didn't ask him to stop, i just let the tears come. I felt absolutely frozen with shock throughout the whole procedure - no one was asking if I was OK so I assumed I was being a bit of a baby. He announced the coil was in place and I was sat up. Lack of compassion Within seconds I was flooded with heat, I wanted to be sick and everything started to go black. The nurse laid me back down and I remember coming round with a fan on my face and my feet elevated on a stool. The nurse seemed very chilled about the whole thing and just said - oh you're a fainter! I am 53 and have only ever fainted once in my life and that was over 20 years ago. The consultant did not even look at me, let alone speak. I actually felt embarrassed and just wanted to get out as fast as possible. I was slowly sat up and the nurse went and got my daughter from the waiting room. My daughter was told that I felt a little bit wobbly and suggested we go get a coffee from the hospital coffee shop, no one checked my pulse or blood pressure and they seemed keen to get on so we dutifully left. I felt horrific. I couldn't make it to the coffee shop at first. I had to sit down with my head between my legs twice in the hospital corridor as I felt so faint, sick and hot. I've no idea how I dragged myself to the cafe as I continued to feel so awful. After 30 minutes of this my daughter went to get help. She was advised to get a wheelchair and take me back to the clinic which she did. We were laughingly told by the receptionist that I wasn't the first and wouldn't be the last and that we were welcome to sit in a quiet room until I felt better. She brought me a cup of tea but no nurse checked on me at all. It took almost an hour after the fitting before I could stand for long enough to get out to the car. We just sort of slunk out and that was it. Later when I felt better, I checked my sports watch data. My heart rate had averaged 46 for over 30 minutes with the lowest reading being 38 beats per minute. Left in disbelief but inspired to advocate for change How is this happening in 2024? The thought of ever having another pelvic exam, smear test or anything else makes me feel sick and shaky. Where do people go for support with this? It's not ok. I work in Primary Care and often refer women on the same pathway I have just been through. I will absolutely be raising my concerns with the care provider involved. I also have since spoken to a number of women of perimenopausal age and have been horrified to hear so many upsetting experiences from others. It does seem that there is an embedded culture within gynaecological care within which women are neither heard nor permitted agency over their own bodies. Two weeks on and I am feeling far less traumatised, but incredibly inspired to help bring an end to this poor treatment of women. It can be easier to speak up in advocacy than solely for oneself. Share your experience Have you had a gynaecological procedure recently? Would like to share your experience - positive or negative? What makes the difference when it comes to feeling safe or unsafe when accessing these services? You can comment below (sign up first for free), or contact our editorial team at [email protected]. You can also add your experience of a hysteroscopy or IUD procedure to our community forum. Pain during IUD fitting Painful hysteroscopy Related reading Pain experiences during intrauterine device procedures: a thematic analysis of tweets (11 June 2024) Failures of informed consent and the impact on women’s health: a Patient Safety Learning blog Gynecology has a pain problem Our discomfort is routine. What if it didn’t have to be? (1 June 2022) Fitting coils: developing a safe and supportive service The ripples of trauma caused by severe pain during IUD procedures (BMJ Opinion, July 2021)
  13. Content Article
    We all communicate multiple times a day but could we be getting better results? From a simple text or phone call, to a job interview or big presentation, the way we express ourselves and get our point across can really matter. On the Communicating podcast, Ros Atkins and his guests reveal the best ways to communicate and how simple changes in the way we make our point can be really effective. In this episode, Ros speaks to Dr Rob Elias, a kidney consultant at King's College Hospital in South London. Ros and Dr Elias discuss the role of empathy in communication, the need to calculate how much information someone is able to digest, and the need to make effective communication a priority.
  14. Content Article
    Failures in interpersonal communication are considered to be the main cause of serious avoidable incidents in high-risk settings. The European Institute for Safe Communication (EISC) aims to prevent these incidents by the promotion of interpersonal "safe" communication skills. The EISC website explains how safe communication can be achieved through the SACCIA approach. SACCIA is an acronym that summarises the five communicative practices that, according to extensive scientific analysis, repeatedly lead to avoidable harm. At the same time, these five practices represent evidence-based core competencies for "safe communication," because they convert harm-triggering communication weaknesses into competencies. Beyond these safety practices, fundamental misconceptions about interpersonal communication are also being addressed. The letters "SACCIA" stand for Sufficiency, Accuracy, Clarity, Contextualisation and Interpersonal Adaptation.
  15. News Article
    A 26-year-old woman died after she was subjected to a “frankly barbaric” Brazilian butt lift procedure without giving informed consent, a coroner has ruled. Demi Agoglia travelled to Turkey for the operation after seeing celebrity endorsements for Istanbul-based Comfort Zone Surgery on social media. Her partner, Bradley Jones, said he had not wanted Agoglia to have the surgery but she had booked the trip months earlier after seeing “some celebrity” endorse it online. Immediately after the operation she was “shaking” and appeared “very, very cold”, he told Bolton coroner’s court. Staff from Comfort Zone were called to the villa where she was staying after Agoglia complained of a tight chest, and they checked her blood pressure, but did not inspect the area of the operation or check her heart rate and pulse, the inquest heard. Agoglia then collapsed at the villa and was taken back to a hospital in Istanbul where she died on 8 January, three days after the operation. It later emerged that the Comfort Zone staff who were called out to the villa were not qualified nurses. The inquest heard that their “completely bizarre” actions included trying to feed pieces of cucumber to Agoglia after she collapsed. Dr Omar Tillo, a Harley Street consultant plastic surgeon, told the inquest: “The lack of proper care and response, particularly the failure to address post-operative complications, are likely to have played a significant role in Demi’s tragic outcome.” The Bolton coroner, John Pollard, ruled that the medical cause of death was a microscopic fat embolism in which tissue leaks into the bloodstream. Concluding that Agoglia had died as a result of misadventure contributed to by neglect, he said: “I find there was no proper informed consent in this matter, there was no proper pre-operative care and advice, and no proper post-operative care. “All of this meant the care in total fell well below the standard expected of this type of treatment and the lack of care contributed significantly to Demi’s death.” Read full story Source: The Guardian, 11 December 2024
  16. Content Article
    This article in Mayo Clinic Proceedings looks at the impact that doctors' communication can have on patients with serious illness. Acknowledging the challenges of such communication, the authors of this article argue that certain words and phrases—'never-words'—should be avoided as they can close down a patient's ability to speak openly with their healthcare team, affecting the safety and quality of their ongoing care. The article lists these words and phrases, offering alternative language that doctors and other healthcare professionals can use.
  17. Event
    The 2024 EIDO conference, ‘The Consent Conundrum: Legal Insights and Practical Solutions’, explores medical consent through various lenses. Taking place on Tuesday 26 November at the East Midlands Airport Raddison Blu Hotel, this FREE event is open to surgeons, consultant nurses, legal service managers and anyone with an interest in shared decision making and informed consent. Reasons to attend the EIDO conference: Get FREE access to EIDO’s CPD-certified e-learning course The Legal Aspects of Informed Consent: Foundation Course after the event Gain insight into medical negligence, international perspectives on consent, and collaboration in patient information. Listen to expert speakers discuss digital transformation in patient care, system interoperability and consent issues in recent inquiry reports. Earn CPD points and receive a CPDUK certificate after the event. Register for the conference
  18. News Article
    The jailed breast surgeon Ian Paterson has said he did not tell women if he was going to perform an unauthorised cleavage-sparing mastectomy on them because “it was frightening and they didn’t need to or want to know”. Giving evidence for the first time at an inquest into the deaths of 62 of his former patients, Paterson said he considered a cleavage-sparing mastectomy to be an “adaptation of a standard operation” that did not require separate consent. After previously refusing to give evidence in the hearings, Paterson spoke on Thursday at the inquest of Elaine Turbill, who died, aged 63, in 2017 when her cancer returned after undergoing a mastectomy carried out by Paterson in 2005. The inquest heard that at a recall clinic in 2010, it was recorded that 20% of her breast tissue had been left behind after the operation. Speaking via video link from prison, where he is serving a 20-year sentence for multiple counts of wounding linked to unnecessary operations he carried out on patients, Paterson said he did not explain the procedure in detail to his patients. “Most ladies know what a mastectomy is. I never went into great detail, it scares them and I don’t think they hear it, they just hear the word cancer,” he said. “This lady [Turbill] would have been taken into a separate room with a breast care nurse and would have discussed things in more detail.” He later said: “It was frightening and [patients] didn’t need to or want to know.” Read full story Source: The Guardian, 31 October 2024
  19. Content Article
    All human rights organisations set forth codes by which they align their purposes and activities. The Mental Health Declaration of Human Rights articulates the guiding principles of the Citizens Commission on Human Rights and the standards against which human rights violations by psychiatry are relentlessly investigated and exposed. The Mental Health Declaration of Human Rights was created by Citizens Commission on Human Rights (CCHR) International, a mental health watchdog based in Los Angeles. CCHR is responsible for helping to enact more than 180 laws protecting individuals from abusive or coercive practices. CCHR has long fought to restore basic inalienable human rights to the field of mental health, including, but not limited to, full informed consent regarding the medical legitimacy of psychiatric diagnosis, the risks of psychiatric treatments, the right to all available medical alternatives and the right to refuse any treatment considered harmful. The Mental Health Declaration of Human Rights is found online at https://www.cchr.org/about-us/mental-health-declaration-of-human-rights.html. Under the banner of the Mental Health Declaration of Human Rights, tens of thousands of people around the globe have joined CCHR and taken to the streets to protest psychiatric drugging and other inhumane mental health practices. Find out more about CCHR and its work to investigate and expose psychiatric fraud and abuse.
  20. Content Article
    Dan Cohen is an international consultant in patient safety and clinical risk management, and a Trustee for Patient Safety Learning. In this blog, Dan discusses the four principles of medical ethics, specifically focusing on how each applies to providing safe patient care. Our moral imperative Having spent more than 50 years as a doctor, I have come to appreciate that everything in my, and our, professional life comes back to the basics of why we entered the healthcare professions in the first place. We genuinely wanted to help people, to keep them healthy and to return them to their maximum healthy state when they became ill. We wanted to serve our patients by being helpful. This has been our moral imperative and our beacon. This moral imperative is the reason we get up every day and go about our jobs, often working under stressful circumstances confounded by environmental stressors, liabilities related to human factors and process inefficiencies. All of these factors have an impact on our effectiveness in clinical settings, with stress and burnout also trickling over into our personal lives. Providing healthcare is challenging, especially when so much of our work environment is seemingly out of our control. Yet we keep coming back for more because we really care. Healthcare professionals may be viewed as special and unique people by many in society, sometimes even put on a pedestal. But really, they are mostly ordinary women and men, drawn by an important calling with highly specific and serious responsibilities. What we do is special and unique! Healthcare professionals try to provide the highest quality care, focusing on optimal clinical outcomes while avoiding mistakes, errors and harm to patients. We also acknowledge that what matters most to patients influences our approach to their care. How we satisfy our moral imperative is governed substantially by adhering to the medical ethics; i.e., the behaviours, actions and deeds that are held within the moral imperative. Behaviours that do not align with the moral imperative are considered unethical. The principles of medical ethics The principles of medical ethics have been best characterised by four foundational pillars, first elucidated by Tom L. Beauchamp and James F. Childress in 1979 in their seminal book, Principles of Biomedical Ethics.[1] These principles remain as relevant today as they were when first described. I will discuss briefly these foundational pillars, specifically focusing on how each applies to providing safe patient care. Principle 1: Respect for patient autonomy Providing healthcare should be a collaborative process with professionals and patients working together to achieve the best outcomes. Therefore, patients’ needs, wants and expectations should be foremost. Optimal outcomes, especially in outpatient care, cannot be achieved without patient engagement, as the patients are generally the implementers of care, certainly after they leave their doctors’ surgeries. Patients are entitled to be informed about the risks and benefits of interventions that may cause them harm, surgical interventions most notably, and this requires discussions and sharing of information to ensure patients are appropriately involved in decision making. The practice of obtaining signed patient consent for surgical procedures acknowledges this. However, consent is often obtained in a 'slap-dash' way by having patients sign forms that may be incomplete or incompletely understood by patients. The informed consent process, as it has been operationalised, may satisfy legal requirements but is often flawed as it may not generally include a thoughtful doctor to patient discussion of risks and benefits. Respect for patient autonomy absolutely requires adherence to the principle of candour in healthcare. If mistakes are made in providing care, patients deserve to have these mistakes discussed with them in a timely fashion. This generally means shortly after the mistake has been discovered and is especially crucial with mistakes that have caused harm or may cause delayed harm. Until patients release us from our responsibilities as their care provider, we must remain committed to satisfying their healthcare needs. This cannot be accomplished if we are not honest and candid when discussing what has happened. There is now good evidence that candid discussions decrease the frequency of medical negligence claims and lawsuits and the size of healthcare injury claims paid.[2] [3] Caring for patients means respecting them and sharing information with them, whether that's for the better or worse. Principle 2: Beneficence Healthcare professionals are required to provide care that is intended to be beneficial to patients. It may seem counterintuitive to say this, but what this really means is that the care provided should be evidence-based and comply with the highest standards designed to achieve best outcomes. There are certainly instances where evidence is lacking or controversial or where doctors and/or professional groups may disagree regarding the best care and how to achieve best outcomes. Yet each healthcare professional must aspire to provide the best possible care, even in the face of uncertainty. And if there is uncertainty, then that uncertainty also should be discussed with our patients. This principle requires that healthcare professionals be willing to discuss "alternative approaches" to standard healthcare therapeutics if patients bring these options into the discussion, including the use of acupuncture, homeopathic and/or herbal products, and other approaches that patients may wish to consider. After all, patient autonomy must be respected, so professionals, regardless of their own opinions regarding these interventions, must be willing to listen and provide relevant information in a compassionate way. It is important to point out to patients when some of these alternative approaches may be harmful in certain situations. For example, certain herbal treatments may pose risks for patients taking oral anticoagulants. Healthcare professionals must share their concerns about what risks are known and mention when risks are not known. I have come across this dilemma in my own practice and I would be honest and say something like: “I cannot say with confidence that what you wish to do will be safe or unsafe, because I simply do not know the answer, although I will look into this more thoroughly. However, if I cannot find evidence of safety, then I cannot fully support you using 'XYZ' because I will be concerned that it may be harmful. The choice is always yours, and I respect your decision even if it is not one that I would make myself". Principle 3: Nonmaleficence This principle, which some have interpreted simply as "do no harm" is actually more complex than that. By their very nature, some of our recommendations cannot always avoid harm. So, by extension "do no harm” really means to avoid unnecessary harm to the extent that this is possible. For example, for a patient undergoing surgery, the surgeon will use a scalpel to perform the surgery. Hence the surgeon must actually harm the patient in order to perform the surgery, and that harm could lead to further harm (e.g., bleeding, infection, etc.) that was never the intention of the intervention. In the same way, chemotherapy to treat cancer may carry substantial risks of harm because of medication side effects that cannot always be avoided. This is the reason that informed consent must address the risks and benefits of the treatment, and professionals must make sure their patients fully understand these risks and benefits. Nonmaleficence means to avoid unnecessary harm whenever possible. Principle 4: Justice Sadly, even in our caring professions, not all of our patients are treated fairly and equitably. The principle of justice requires that all patients be treated without reference to their genetic, biological, social and economic backgrounds, gender or gender identity, and political views. The impacts of prejudices and biases against individuals of differing ethnicities, skin colours, social classes, political views, and coincidental health and lifestyle issues have adversely influenced both access to healthcare services and the quality and timeliness of healthcare services provided, possibly resulting in adverse healthcare outcomes.[4] [5] [6] For example, individuals with obesity and smoking related comorbidities and illnesses are often viewed as "responsible" for their health challenges and subject to biases, whereas recreational middle distance runners are rarely viewed negatively for their anterior cruciate ligament (ACL) injuries or joint osteoarthritis. Healthcare professionals thus have a moral obligation to acknowledge this vulnerability in themselves and to never let these biases or prejudices interfere with our provision of care. Our prejudices may well harm patients and/or prevent them from achieving optimal healthcare outcomes. This is particularly an issue when professionals are working under stress and task saturation, when we tend to take shortcuts in diagnosis and may rush to solutions or be less sympathetic and compassionate to those who are "not like us". Disparities in care are dangerous variables when providing safe, high-quality healthcare for everyone. Summary The principles of biomedical ethics apply directly to the fundamental moral imperative to provide the highest quality care while avoiding mistakes, errors and harm to patients. We must ensure that what matters most to patients influences our approach to their care and, thus, to adherence to this moral imperative. The foundational pillars of medical ethics also require professionals to be honest with patients when things go wrong and to focus on sustaining the relationships between patients and their care providers. Therefore, healthcare professionals are advised that before walking into their clinics, surgeries, hospitals, etc., they should stop and pause momentarily to reflect upon who they are as professionals, the moral imperative they work under and the professional behaviours that must align with the moral imperative. We must recognise the challenges of working in a complex environment and be especially careful. Stress degrades behaviour for all of us and, from time to time, I have been as much at fault as anyone. It’s called being human. Be part of the solution, not part of the problem. References Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 8th Ed. Oxford University Press, USA, 2019. Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine 2010; 153(4): 213–21. Kachalia A, Sands K, Van Niel M, et al. Effects Of A Communication-And-Resolution Program On Hospitals’ Malpractice Claims And Costs. Health Affairs 2018; 32(11): 1836–44. Lavizzo-Mourey RJ, Besser RE, Williams DR. A Half-Century of Progress in Health: The National Academy of Medicine at 50: Understanding and Mitigating Health Inequities — Past, Current, and Future Directions. N Engl J Med 2021; 384:1681–4. Sabin JA. Tackling Implicit Bias in Health Care. N Engl J Med 2022; 387:105–7. Fernandez A, Chin MH. Keep Your Eyes on the Prize – Focusing on Health Care Equity. N Engl J Med 2024; 390:1733–6. Further reading on the hub from Dan: Clarity and the Art of Communication for Patient Safety Late night reflections on patient safety: commentaries from the frontline (2014) Diagnostic errors and delays: why quality investigations are key Patient Safety Spotlight Interview with Dr Dan Cohen, Patient Safety Learning Trustee Structures, processes and outcomes for better or worse: Personal responsibility in patient safe care What does all this safety stuff have to do with me? How one professional’s arrogance led to new insights Interview with Dr Dan Cohen on human performance
  21. Content Article
    Words convey empathy, demonstrate competence and generate trust in conversations between patients and healthcare providers. Small wording changes can affect the nature of interactions and the outcomes of an appointment or visit. This JAMA article provides examples of how subtle changes in word choice affect the information patients provide, patients’ uptake of information from healthcare professionals and patients’ adherence to recommended interventions.
  22. Content Article
    The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) is a UK organisation that investigates the outcomes and deaths of patients in hospitals. In this report NCEPOD summarises common themes that have come out of their reports. Multidisciplinary review Communication with family, parents and carers Consent Monitoring and early warning scores Documentation Transition planning Clinical networks Local policies, protocol, proforma and guidelines Follow-up post discharge
  23. Content Article
    In a previous article, Charles Binkley argued that patients should be informed when AI is used in making their healthcare decisions. This article explores the range of potential harms attributable to AI models and ask whether informed consent alone mitigates responsibility.
  24. Event
    EIDO Healthcare’s upcoming in-person conference on 26th November will focus on how improving informed consent practices can directly enhance patient safety. The event is organised by Julie Smith, EIDO’s Content Director and a topic lead for Patient Safety Learning's hub. ‘The Consent Conundrum: Legal Insights and Practical Solutions’ will explore how medicolegal expertise and practical approaches to informed consent can prevent medical negligence and improve patient outcomes. Discussions will include case studies highlighting patient experiences, the latest updates on consent, and the crucial link between informed consent and patient safety. Speakers include: Simon Hammond, Director of Claims at NHS Resolution Mr Parv Sains, Medicolegal Lead for RCS England and ASGBI Jonathan Webb, Head of Safety & Learning, Welsh Risk Pool Professor Vivienne Harpwood, Emerita Professor of Medical Law and Ethics, Cardiff University Helena Durham, Lay Patient Safety Partner and member of the Ethics of Clinical Practice Committee at Nottingham University Hospitals NHS Trust Attendees will receive a CPD Certificate and complimentary access to EIDO’s foundation e-learning course, “The Legal Aspects of Informed Consent” following the event. Spaces are limited and free, so don’t miss this opportunity to join vital discussions on improving patient safety through better informed consent practices. Register here.
  25. Event
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    This Patient Partnership Week webinar will ask the question, "Why aren't patients treated as equals in their own care?" Prof Havi Carel from the University of Bristol will discuss why some healthcare professionals ignore, dismiss or explain away patients' testimonies about their health. Register for the webinar
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