The Illusion of Perfection: Part 2 • LITFL • Peak Performance

Do You Remember That Patient?

How to Break the Silence and Change the System

“Do you remember that patient?”
Five words. That’s all it takes to pull you back into the chaos.
Back into the sweaty palms, the racing heart, the pit in your stomach.
Because we always remember.

The miss.
The moment.
The aftermath.

In Part 1, we dismantled the illusion of perfection.
In Part 2, we build something better.

The Problem Isn’t the Mistake – It’s the Silence That Follows

Here’s the hard truth:
What drives lawsuits isn’t the error.
It’s the silence.
It’s the legal advice to “say nothing.”
It’s the inhuman pause when families ask, “What happened?” and we retreat into policy and fear.

Defensive medicine becomes our shield. Unnecessary scans. Extra tests. Not for clarity—but for protection.
And it’s killing us.
Costs explode. Trust crumbles. Nurses go quiet. Doctors detach. Patients suffer.

And under it all, an entire system built on fear instead of truth.

This is where open disclosure enters.

Enter CARe: The Blueprint for Being Human Again

CARe = Communication. Apology. Resolution.
It’s not just a protocol—it’s a rebellion against the silence.
Born in Massachusetts. Spreading globally. Known by different names, but powered by the same engine: empathy plus action.

Chris Nickson from LITFL has discussed this before in his post open disclosure. So has British Columbia, where I trained in the CUO program—Communicating Unanticipated Outcomes.

At its core, open disclosure is medicine done right:

Real talk.
Real compassion.
Real change.

Let’s break it down.

The Three Principles of Open Disclosure

You have permission.
Every province in Canada has an “apology law.” Saying “I’m sorry” is not an admission of guilt. It’s a human response, and it’s protected.
You don’t have to do it alone.
Disclosure is a team sport. Prepare. Support each other. Have backup.
It’s emotional—for everyone.
This isn’t just a medical conversation—it’s a human one. Expect tears. Expect anger. Expect impact.

The Three Steps to Starting Disclosure

1. Clinical Needs

First, stop the bleeding. Literally and figuratively.
Is the patient’s acute issue addressed?
Remove the allergen. Reverse the insulin. Stabilize the now.

2. Emotional Needs

Then, hold space.
Before answers, offer empathy.
Ask who they need in the room.
Anticipate grief. Mirror their humanity.
Sometimes, this is where it ends—for now. Don’t push past someone’s emotional threshold.

3. Informational Needs

Only once they’re ready: offer what you know.
Not what you think. Not speculation.
No grey-zone storytelling to fill the awkward gaps.
This is a first conversation, not the final word.
Say: “We’ll follow up.”
Then actually follow up.

Barriers? Oh, There Are Plenty.

Timing. There’s no perfect moment between back-to-back trauma codes.
Fear of litigation. Even with apology laws, the instinct to lawyer up runs deep.
Training gaps. Most of us were never taught how to do this. We just watched our mentors clam up.
Ego. Admitting error shatters the identity we built to survive med school.

But the greater cost is not doing it.

What It Looks Like When Done Well

(Thanks to Chris Nickson for this elegant summary)

Set the stage. Right time. Right place. Right people.
Acknowledge the event and its impact.
State clearly: “I’m sorry.”
Let them talk. Really listen.
Share the plan: what you’ll do, how you’ll prevent this again.
Document it. Report it. Learn from it.

This Is Not a Compliance Box. This Is a Moral Imperative.

Open disclosure isn’t just about safety.
It’s about healing.
Not just for the patient and family—but for you.
The provider. The human who showed up to do good.
You can’t heal others while bleeding guilt.

So take care of yourself. Forgive yourself.
Lean into your team. Use peer support. Call the programs.
Don’t just survive the system. Change it.

Start Here. Learn More. Take Action.

This isn’t theory. This is implementation.

United States

Canada

Australia

New Zealand

HDC Open Disclosure Policy

UK

Train Healthcare – Open Disclosure

Final Thought

This isn’t easy work.
It’s vulnerable. It’s uncomfortable. It will stretch you.
But if we want to rebuild trust in medicine, we have to lead with humanity.

The next time you hear, “Do you remember that patient?” — you’ll know what to do.
You’ll lean in. You’ll tell the truth.
And you’ll start the process of healing—for everyone.

Neil Long

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.