School of Medicine, University of Queensland, Brisbane, QLD, Australia.
Med J Aust. 2013 May 6;198(8):445-8. doi: 10.5694/mja12.10734.
Open disclosure (OD) after adverse health care events is the subject of a national standard that has been implemented in state health policy documents, and is included in the Medical Board of Australia's code of conduct for doctors. Nevertheless, doctors have been slow to embrace the practice of OD. There is a strong ethical case for implementing OD in the primary interests of patients, and additionally from a medicolegal risk management point of view. There are no statutory requirements in relation to OD, but common law judgments have imposed a duty of OD in tort and contract. There are a number of barriers to the better uptake and implementation of OD, including perceptions of legal risk, lack of education and training, reluctance to admit error, uncertainty concerning what and how much to disclose, and the variations in state and territory "apology laws". The implementation of OD could be improved by making apology laws consistent across jurisdictions, including providing "blanket" cover for admissions of fault; by preventing insurers voiding contracts when apologies are made, either through self-regulation or legislation; and by inserting OD obligations into different structures within the health system.
医疗不良事件后的公开披露（Open Disclosure，OD）是国家标准的主题，该标准已纳入州卫生政策文件，并包含在澳大利亚医学委员会医生行为准则中。尽管如此，医生们还是迟迟不愿接受 OD 实践。从保护患者的主要利益，以及从医疗法律风险管理的角度来看，实施 OD 具有很强的伦理意义。OD 没有法定要求，但普通法判决在侵权和合同中规定了 OD 义务。OD 更好地采用和实施存在许多障碍，包括对法律风险的看法、缺乏教育和培训、不愿承认错误、不确定要披露什么和多少、以及州和地区“道歉法”的差异。通过使司法管辖区内的道歉法保持一致，包括为过失承认提供“全面”保障；通过防止保险公司在道歉时使合同无效，无论是通过自我监管还是立法；并通过将 OD 义务插入卫生系统内的不同结构，可以改进 OD 的实施。
