Événements iatrogènes en réanimation : comment informer le patient et sa famille ? Le point de vue du réanimateur

Studies about iatrogenic complications do not include patient and/or family information-related problems. We sent a questionnaire by e-mail to 30 doctors working in the medical intensive care units of six university hospitals of the Western part of France; answers were stratified in two groups according to doctors' age and duration of intensive care experience. 55% of doctors inform the patient if possible and the families about the risks of occurrence of such events, but according to the type of procedure involved for 70% of answers; 88% inform the patient if conscious and 91% inform families about a iatrogenic complication once it has occurred, without difference between the two groups. Only 40%, nearly all among the older doctors, state knowing well the recommendations of the French-speaking society of intensive care medicine (SRLF) whereas the younger doctors state knowing them poorly or not at all significantly more than the older doctors. Information about risks is required by the French official medical code of pratice and by the recent 4th of March 2002 law, except in an emergency setting. In case of unconsciousness or impaired mental status, the doctor must inform the family or the patient's surrogate if designated. Information must be given about frequent and serious complications, such as death or severe disability, even if the risk is exceptional. The National Consultative Committee on Ethics (CCNE), the National Health Accreditation Agency (ANAES) and the SRLF have published recommendations underlying the importance of an oral discussion and considering, as justice courts, written information to be only a supplement. Proof that an adequate information was actually delivered is the doctor's responsibility and should be kept it the patient's file. Finally, one should keep in mind a double psychological difficulty in delivering such an information: for the patient and his family due to a difficult emotional context on one hand and for the doctor who may have the impression that his competence is questioned on the other hand.