Emotional harm from disrespect: the neglected preventable harm

Abstract

Consider these actual patient experiences: 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 …