How communication is tested on Step 1
Choose the response that is honest, empathic, and invites the patient to take part.
- Interpreters: use trained medical interpreters; avoid family members, especially children. Look at and speak to the patient.
- Open-ended questions early in the interview; summarize and use teach-back to confirm understanding.
- Angry or upset patients: acknowledge the emotion and apologize for their experience before problem solving.
- Requests for unnecessary tests or drugs: explore the reason behind the request rather than refusing outright.
Behavior change
Meet patients where they are.
Medical errors and disclosure
Honesty is required whether or not harm occurred.
| Term | Meaning |
|---|---|
| Near miss | An error caught before it reached the patient |
| Adverse event | Harm caused by medical care (may or may not be preventable) |
| Sentinel event | Unexpected event causing death or serious harm; triggers root cause analysis |
| Never event | Serious, preventable event that should never occur (e.g., wrong-site surgery) |
| Active error | Error by the person at the point of care |
| Latent error | Hidden system flaw (design, staffing, policy) |
Disclosure includes what happened, an apology, what is being done for the patient, and how recurrence will be prevented.
Systems safety and quality improvement
Most errors come from systems, not individuals.
- Swiss cheese model: each layer of defense has holes; harm reaches the patient when the holes line up.
- Quality measures (Donabedian): structure (resources), process (what is done), and outcome (results).
- Cognitive bias in diagnosis: anchoring, availability, and premature closure contribute to diagnostic error.
Worked example
Disclose, even when no one would know.
functions Worked example — the extra dose
A resident realizes a patient received a double dose of a medication overnight. The patient had no harm and is unaware. A colleague suggests saying nothing. What should the resident do?
- Medication errors that reach the patient should be disclosed, even without harm.
- Tell the patient honestly what happened, apologize, and explain monitoring.
- Report the event through the hospital's safety reporting system.
- The institution reviews system causes (such as order entry or handoff problems) to prevent recurrence.
Answer. Disclose the error to the patient, apologize, monitor, and file a safety report.