Feedback, either giving or receiving, is one of the most difficult situations we face at work. Feedback is part of the work environment whether we work in a hospital, a fast food outlet, or a corporation. As physicians, we have all received feedback as part of an evaluation during which there is usually a discussion of things done well, and things that need improvement. That kind of feedback is quite different from that in this case.
In this situation, feedback is given by a colleague on a perceived error – a breach of ethical principle. In the self-regulated profession of medicine, this kind of discussion should and does occur all the time. Ideally, each physician self-regulates and recognizes when they have committed an error. Physicians also need to recognize that feedback from colleagues can be beneficial.
Sometimes, depending upon the situation, a report to the provincial/territorial college or other authority should also be made.
In this case, although the error might seem trivial, it points to Dr. Johannson’s lack of insight into his behaviour. Note that Dr. Beltan first asks for Dr. Johannson’s side of the issue. In any instance of feedback, it is important that all parties feel that they have been heard. Does this happen here? Do we get an adequate idea of Dr. Johannson’s view of the issue?
Dr. Beltan further attempts to keep the conversation on a factual, non-emotional level. This is also important in any feedback situation. Which of the MCC Objectives address this point?
Does Dr. Johannson admit his mistake or show any remorse? Defensiveness is common in these situations and can escalate the conflict. Although it might not be possible to obtain an admission during the feedback conversation, one hopes the person will reflect and change their behaviour. Humiliation is not the desired outcome.
Finally, Dr. Beltan suggests that Dr. Johannson read some reference documents to appreciate the seriousness of a breach in confidentiality, and to understand how confidentiality is regulated.
Dr. Johansson is subject to medical employee bylaws on maintaining patient confidentiality and to the possible consequences if they are not followed. Health-care organizations track and audit access to patients’ health-care information. Inappropriately accessing patient information can lead to disciplinary action.
The regulatory authorities in each province and territory have strong statements supporting the confidentiality of patient information. There are also provincial/territorial and federal laws that outline the responsibilities physicians and institutions have regarding respecting and protecting a patient’s health information.
In this case, if it is determined that this incident was an isolated one, that Dr. Johansson appreciates the significance of his actions and takes steps to change his behaviour, then no further action is required. However, asking Dr. Johannson to present the topic of confidentiality during grand rounds generalizes the problem and allows others to benefit. This course of action might also help Dr. Johannson view the conversation in a more positive light. Had Dr. Beltan been concerned about this situation recurring, or if he believed that Dr. Johannson failed to appreciate the significance of this issue, then further action would be required.