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When medical care doesn’t turn out as expected: disclosing adverse events :

November 21, 2016

Despite pediatricians’ best efforts, sometimes sick and injured children don’t get better. And occasionally, they even get worse.

A new AAP policy statement, Disclosure of Adverse Events in Pediatrics, advises pediatricians that honesty and transparency in communications with patients and families when things go wrong can help patients, families, pediatricians and the physician-patient relationship itself.

There is broad consensus that open and honest communications are ethically indicated when medical care doesn’t turn out as expected. Additionally, increasing evidence indicates that such communications can promote a culture of safety and reduce the consequential harms to patients after medical errors. Honesty and transparency may strengthen physician-patient relationships, improve patient outcomes and lessen the secondary adverse effects on families and physicians.

The policy explores efforts state legislatures have made to encourage disclosure about adverse events and encourages further efforts to promote disclosure.

The statement from the AAP Committee on Medical Liability and Risk Management and the AAP Council on Quality Improvement and Patient Safety is available at and will be published in the December issue of Pediatrics.


  • Pediatric health care providers and institutions should develop and implement their own policies and procedures for identifying and disclosing adverse events to patients and families in an honest and empathetic manner, as part of a nonpunitive culture of medical error reporting.
  • Pediatric institutions and practices should develop policies and procedures to provide emotional support for clinicians involved in adverse events.
  • Pediatric medical educators should develop and implement educational programs regarding identification and prevention of medical errors and communication about adverse events with patients and their families as part of a comprehensive patient safety curriculum.
  • Additional research is needed on the consequences of various approaches to disclosure, as well as of the effectiveness of disclosure education.
  • State legislators and other governmental and regulatory bodies are encouraged to continue developing apology laws and other mechanisms to reduce liability risks associated with disclosure.

“Pediatric medical care may not always result in the ideal outcomes that pediatricians strive to achieve,” said William M. McDonnell, M.D., J.D., FAAP, immediate-past chair of the AAP Committee on Medical Liability and Risk Management and co-author of the policy statement. “But our patients and their families need to know that we will be open and honest with them, whatever the outcome.”

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