Why open disclosure was required for Greig?

By "open disclosure," we mean the communication and support provided by physicians to

patients and/or their families, careers, or other support persons who have suffered harm as a

result of medical treatment (Holmes et al., 2019). Patients have a right to full disclosure, which is

also a cornerstone of professional ethics, a hallmark of excellent clinical practice, and an integral

component of the care delivery process. Twenty years of research have shown that patients and

professionals engaged in adverse occurrences benefit from open disclosure. Organizations can

learn and improve their treatment for future patients if they are allowed to discuss unfavorable

experiences openly. The act of open disclosure can be taxing on all parties involved. Its

methodical application, however, can aid health service organizations in compassionately

managing adverse occurrences and providing larger benefits via enhanced clinician

communication and system enhancement.

For the case of Greig open disclosure was done because that is the only way that his life was to

be saved. Everyone who took part in this Korean study saw the value in being completely

transparent, despite worries that open disclosure may be less appropriate in non-Western

countries (Xiao et al., 2022). Many people have argued that open disclosure should be done

regardless of the consequences or benefits it may bring. Due to the gravity of the issues at stake,

they felt that full transparency was essential in the healthcare sector. The Institute of Medicine

has identified patient-centered care as one of the primary aims of healthcare improvement, and

open disclosure is beneficial in terms of both patient safety and patient-centered care. What

patients and caregivers think is right and incorrect should be given more weight.

Legal implications Roderick McRae

At the time of the murder, McRae was serving in the military as a military police officer

(Odartey et al., 2020). His marriage to his wife had been troubled for some time, in part because

he suspected her of infidelity when he was away on an international assignment. He admits to

making remarks to many witnesses outside of her presence throughout the final year of her life

that he intended to kill her. While the jury may have reasonably inferred that some of these were

made in jest, there was evidence to suggest that others were intended to be taken seriously.

Specifically, the evidence demonstrated that he threatened to blow her brains out with the

identical gun he eventually used to do so, even when seen in the most advantageous perspective

for the guilty conviction. 1 He later said he had discussed murdering her with an attorney and

was confident he could "beat it." Several times he threatened to murder her and used slang to

describe her in horrible terms since he did not want her to raise their children.

Due to their troubled relationship, Mrs. McRae and McRae had arranged that he would spend a

few days in the barracks on the day she died. He had planned to move out that afternoon, but

when he got home he found friends visiting, so he left again. She accompanied him to the car as

he left. There, they exchanged angry words before he drove off to the barracks, with McRae

ordering her to leave before he came back. He hung around for a while, drank some beer, and

made more irate threats to murder her before finally leaving. Once he got back to the house, his

wife was scolding him and dinner was cold. After shooing the kids into the bathroom, he

retrieved the rifle from its rack in the living room. He went to the bedroom and got a bullet

before coming back into the living room, where his wife was seated. He loaded the revolver and

chambered a bullet while he chatted with her. He stated that he cocked and loaded the revolver

before walking toward his wife in response to her invitation. As he entered the room, the pistol

went off, fatally wounding Mrs. McRae with a shattered skull.

Leaving his kids in the toilet, McRae extracted the expended cartridge, put it in his pocket, and

drove two houses down to see a neighbor who had asked to see his pistol. He was extremely

irritated in front of the neighbors and told the woman of the home to watch his kids since his

wife was "not all right." He got in his car and proceeded to the barracks, where he confronted a

colleague MP by confessing that he had just murdered his wife and inviting him out for a beer.

When his wife became ill, he did nothing to check on her or help her. He stated that she was

obviously dead and that he did not want to touch her. The images presented as proof corroborate

his claims without any doubt. After an uneventful investigation and trial, McRae was convicted

guilty of murder with malice by a jury.

Open disclosure is valuable because it reduces medical lawsuits, increases patients' faith in

doctors, makes them more likely to return to the same doctors and hospitals, improves patients'

contentment, and lessens doctors' feelings of guilt (Choi et al., 2019). Participants in this study

were mostly positive about these benefits, but some did express skepticism. In particular, doctors

were skeptical that greater transparency would help them avoid costly lawsuits. Previous

research has shown mixed results on whether or not open disclosure increases the probability of

litigation from the general public, with one survey showing a sizable number of doctors

disagreeing with this conclusion. Moreover, two observational studies found that open disclosure

decreased the frequency of medical litigation and the expenses associated with them. Physicians'

comprehension of the situation can be improved by spreading the word about the benefits of

open disclosure in regards to medical lawsuits. Since most prior studies have been undertaken in

western countries, further study is needed to evaluate the effects of open disclosure on medical

lawsuits in non-western countries. The Reasons for Being Honest When it comes to public

transparency, there is also a surprising issue. More crucially, there were differences in opinion
between doctors and the general public regarding the goals of open disclosure based on the

specifics of patient safety occurrences. To begin, there was widespread agreement across the

group that serious medical mistakes must be made public. However, some doctors have said they

wouldn't engage in full disclosure for mistakes that only result in small injuries. In addition,

similar to the results of the other investigations, some doctors showed significant aversion

toward open disclosure of near misses. We anticipated there would be debate about whether or

not near-misses must be publicly disclosed. A more compelling argument, however, is that frank

disclosure of near misses is crucial for the patient's future reference and to prevent similar

medical blunders, as noted by participants from the general public and some clinicians in this

study. It was also observed by Gallagher et al. that individuals who had had a near miss were

better able to recognize potentially harmful medical mistakes.

Choose the clinical audit topic.

Your topic selection should follow a plan. The issue you choose for your clinical audit project

should be one that has the potential to improve the service as a whole, as this investment of time

and energy is not to be taken lightly.

Form a project team

Depending on how many different types of professionals are involved, clinical audit initiatives

are classified as either unidisciplinary or multidisciplinary (i.e. involving more than one

discipline or profession). In order to determine where and how care might be enhanced, it is

crucial that a clinical audit project evaluate the whole clinical team's contribution to patient

treatment. Therefore, it is essential to include members of relevant professions and disciplines on

the project team if its outcomes will have an impact on communities outside of the therapeutic

area in which you operate. Include staff representation from other care sectors in your project

team if your clinical audit project is conducting a "interface" audit, which examines the patient

journey across multiple care sectors. One audit of the interaction between primary care and the

hospital would be an example.

Think about asking patients, service users, and/or caregivers for input, or even better, including

them into the project team. Patient and provider partnerships are essential in healthcare, which is

why interaction is so vital. Despite our best efforts, we recognize that patients and service users

may have varying expectations for what constitutes an acceptable level of care. Participation in

project steering groups or divisional/specialty audit committees, for example, is an excellent

example of direct involvement. However, there is also the option of indirect participation, such

as through the completion of a survey after the conclusion of a course of treatment. It is critical

that your initiative get the backing of coworkers who have the power and willingness to

implement the adjustments recommended by the audit.

Setting objectives

Think about your overarching goals for your clinical audit project in order to identify its purpose.

The purpose might be expressed as a statement about the desired outcome of the audit or as a

question that will guide the direction of the investigation. Statements should be worded in a

favorable light to ensure that the audit leads to actual changes in procedure.

Ethics and engagement

When it comes to ethics, clinical audits are not required to be reviewed by a REC as research is.

For this reason, it's crucial that you label your effort as clinical audit rather than study. Your

division's Clinical Audit Facilitator should be consulted if you suspect that your initiative raises

ethical concerns.It is imperative that all clinical auditing be done so in a morally sound manner.

This includes safeguarding the privacy of patients and staff members and using acceptable data

collection and storage methods, as outlined in the Data Protection Act. The Questionnaire,

Interview, and Survey (QIS) Group must be consulted prior to integrating a patient survey in

your project. The QIS team's information, including how to get in touch with them, are included

at the conclusion of this manual.

Selecting audit sample

The population from which you draw your sample will be determined by the nature of your

research. Sometimes, an audit will be conducted on a universally applicable part of the therapy

or care provided to patients. However, the vast majority of clinical audits evaluate the treatment

of a specific subset of patients based on their shared features. They share a medical ailment, have

undergone the same therapy, or have been visited by the same doctor within the same time range.

Selecting a sufficient sample size is necessary since auditing the whole population of patients is

impractical. For top doctors and managers to be willing to act on your results, you'll need a

sample size that's sufficiently large. For process-based audits, a simple "snapshot" usually does

the trick. It's crucial that your sample consists of recently treated individuals. Clinical audit is

geared toward betterment. Though the past is fixed, the future is malleable.

References
Holmes, A., Bugeja, L., Ranson, D., Griffths, D., & Ibrahim, J. E. (2019). The potential for

inadvertent adverse consequences of open disclosure in Australia: when good intentions cause

further harm. Medicine, Science and the Law, 59(4), 265-274.

Choi, E. Y., Pyo, J., Ock, M., & Lee, S. I. (2019). Nurses' perceptions regarding disclosure of

patient safety incidents in Korea: a qualitative study. Asian Nursing Research, 13(3), 200-208.