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Emotional harm from disrespect: the neglected preventable harm
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  1. Lauge Sokol-Hessner1,
  2. Patricia Henry Folcarelli2,
  3. Kenneth E F Sands2
  1. 1Medicine and Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Lauge Sokol-Hessner, Medicine and Health Care Quality, W/PBS-2, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; lhessner{at}bidmc.harvard.edu

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Introduction

Consider these actual patient experiences:

  • A patient is admitted to the hospital for a bowel obstruction from a known malignancy. She calls her cancer specialist about this complication, but he is unavailable. A covering provider reading from her file says ‘your cancer is untreatable’. This is the first time she has heard this.

  • A patient dies in the hospital and the next day the funeral home collects a body from the hospital morgue. After embalming the body, the funeral home is notified by the hospital that they were given the wrong body. Because of this error, it may not be possible to process the correct body in time for the wake the following day.

Despite being simultaneously dreadful and familiar to healthcare professionals,1 cases like these are not systematically identified or addressed in hospital quality improvement programmes.2 As a result, we have no good way of preventing them and patients inevitably continue to suffer from these unnecessary emotional harms. These cases are examples of preventable harm that are deserving of formal capture, classification and action by the healthcare system.

The 1999 Institute of Medicine (IOM) Report To Err is Human found that existing definitions and systems for preventing harm were inadequate and recommended urgent, decisive steps to raise ‘standards and expectations for improvements in safety’.3 Since then our ability to define, measure and prevent patient harm has improved substantially. For instance, in 1999, central line-associated bloodstream infections were considered unfortunate, but expected complications. Today they are commonly prevented, saving many lives.4

To date, the patient safety movement has focused primarily on physical injury, but definitions of harm in healthcare are much broader:5 any ‘outcome that negatively affects the patient's health and/or quality of life’.6 When asked about consequences of adverse events, patients emphasise emotional …

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