All ophthalmic surgeons have a professional duty to be open and honest when something goes wrong with a patient’s treatment or care that has caused, or has the potential to cause, harm or distress. This is known as the Professional Duty of Candour and is a fundamental aspect of good clinical practice.
Although writing a Duty of Candour letter can feel challenging, a well-prepared, thoughtful letter can help maintain trust, demonstrate professionalism, and support the patient through what may be a difficult experience.
The Professional Duty of Candour
When an adverse event occurs, ophthalmic surgeons should:
- Inform the patient (or, where appropriate, their representative, carer or family).
- Offer a sincere apology.
- Explain what has happened in an open and honest manner.
- Describe the actual or potential short- and long-term effects.
- Discuss any appropriate treatment, support or remedial action where possible.
An apology is not an admission of legal liability. It is an important part of compassionate patient care and professional practice.
Preparing the Letter
Before writing, carefully review the patient’s complete medical records. Preparing a clear chronology of events can help ensure the account is accurate and consistent.
The letter should be typed on hospital or practice letterhead and carefully checked for spelling, grammar and clarity before it is signed.
Write in the first person (“I”) wherever possible and begin by introducing yourself, your role and your involvement in the patient’s care.
Offer a Genuine Apology
Begin with a sincere apology for the distress or harm experienced by the patient.
Avoid wording that could be interpreted as making assumptions about negligence or legal responsibility. Instead, acknowledge the patient’s experience with empathy while providing a factual explanation of events.
Explain What Happened
Describe your involvement in the patient’s care in chronological order.
Include:
- Why the patient was referred to you (where relevant).
- The assessment and treatment provided.
- The events leading up to the incident.
- The recognised complication or unexpected outcome.
- The care and treatment provided afterwards.
Remain objective and factual throughout. Avoid speculation or criticism of colleagues.
Explain the Impact
Clearly explain the known or anticipated short- and long-term consequences of the event.
Use language that patients can easily understand, avoiding unnecessary medical terminology or explaining it where its use is unavoidable.
Where there remains uncertainty about the eventual outcome, explain this honestly.
Explain Any Learning
Where appropriate, reassure the patient by outlining any learning or service improvements that have resulted from the incident.
This may include:
- Changes to clinical pathways.
- Improved documentation.
- Additional safety checks.
- Updated protocols or training.
Patients are often reassured to know that lessons have been learnt and steps have been taken to reduce the likelihood of similar events occurring again.
Be Mindful of the Audience
Remember that the letter may be read by family members, legal representatives, regulators or courts.
Ensure it is professional, accurate and balanced.
If there is any possibility that the incident could give rise to a complaint, regulatory investigation or claim, seek appropriate medicolegal advice before sending the letter and notify your indemnity provider in accordance with your policy requirements.
Offer Ongoing Support
Conclude the letter by inviting the patient to ask further questions and explaining how they can contact you or the appropriate member of the clinical team.
Where appropriate, provide information about additional support services available to the patient.
Final Thoughts
Duty of Candour letters are not simply administrative requirements they are an opportunity to communicate openly, demonstrate professionalism and maintain trust following an unexpected outcome.
Patients value honesty, empathy and clear communication. A carefully prepared Duty of Candour letter can play an important role in supporting patients while also reflecting the high professional standards expected of ophthalmic surgeons.
Where there is any uncertainty about the wording of a Duty of Candour letter or where an incident may have medicolegal implications, it is advisable to seek advice from your medical defence organisation or indemnity provider before the letter is issued.
Please note that this blog is for general information purposes only and does not constitute legal advice. If you require support, please contact the AOOSIS/MIC medico legal team.
