Intended for healthcare professionals

Feature Quality improvement

Patient safety lessons from the world’s experts

BMJ 2018; 363 doi: (Published 27 December 2018) Cite this as: BMJ 2018;363:k5211

Re: Patient safety lessons from the world’s experts

I agree with the report by Jaqui Wise that patient engagement is critical to patient safety. Patient care will only be at minimal risk if all relevant information is available when decisions are being made. Patients do not have technical understanding of risks, but they may have important information which if not disclosed may lead to preventable risk.

A culture of openness is laudable but it may bring its own problems. Whilst it is difficult to see how secrecy could contribute to patient safety, there are broader issues.

Patients may not want to disclose information about illegal or culturally unacceptable behaviour, unless they are confident that their information is closely protected. Yet disclosure may be necessary where there are untoward incidents.

The problem seems to turn on the definition of secrecy and of confidentiality in the relevant context. These concepts need to be defined carefully, agreed locally and made available to staff, patients and when appropriate to their carers.

Before relying on patient advocates to suggest improvements to be made to ensure their safety, there needs to be some reassurance for patients that they will not be penalised, exposed or judged for disclosing relevant information such as illicit drug use, or immigration status.

Competing interests: No competing interests

16 January 2019
Amelia F Robinson
Anaesthetics trainee
Brighton, UK