Over the years some dreadful mistakes have been made in health care, resulting in physical and emotional harm for the unfortunate patients. The situation was partially recognized in the 1999 Institute of Medicine (IOM) landmark report, To Err is Human: Building a Safer Health System, which addressed the inadequate procedures for preventing physical harm that existed in health care at that time.1 The report advised practitioners to take immediate action to raise standards and expectations for improvements in safety.1 Improvements did follow, and over the ensuing years health care practitioners have been able to identify and prevent many situations that would have resulted in physical harm.


A recently published commentary on preventable patient harm used central line-associated bloodstream infections as an example of the impact of the IOM report.2 Those infections are often preventable now, but in 1999 they were actually accepted as predictable and common complications that caused physical—and possibly emotional—harm. The authors are with the Hospital Medicine Program at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, where lead author Lauge Sokol-Hessner, MD, is associate director of Inpatient Quality. With the improvements made in preventing physical harm to patients, Sokol-Hessner and colleagues advise that now the health care profession needs to address emotional harm in a similar way.2 They explained, “Emotional harms can erode trust, leave patients feeling violated and damage patient-provider relationships. Such injuries can be severe and long lasting, with adverse effects on physical health. Failure to acknowledge and systematically address these harms ensures that they continue.”2

Sokol-Hessner and colleagues note that the case for preventing emotional harm and disrespect is at the same stage patient safety was at prior to 1999, before reforms to physical harm were put into place. Emotional injuries are known to occur, but with no system in place to evaluate them, the causes are not understood. Similarly, although evidence suggests that emotional harms may be more prevalent than physical harms, no reliable estimates are available on how frequently they occur. As a result, preventing these harms from happening again is difficult.2

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The 1999 IOM report states “it is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort.”1 Taking this to heart, the BIDMC group invited representatives of various disciplines at the medical center to join a focus group on preventing emotional harms. Thus, the BIDMC Respect and Dignity Workgroup was formed, comprising representatives from the departments of health care quality, patient safety, risk management, performance assessment and regulator compliance, ethics, social work, palliative care, communications, community relations, patient relations, interpreter services, hospital governance, and the Patient Family Advisory Council.