Original Article

Journal of General Internal Medicine

, Volume 22, Issue 6, pp 755-761

The Many Faces of Error Disclosure: A Common Set of Elements and a Definition

  • Stephanie P. FeinAffiliated withDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California at Los Angeles Email author 
  • , Lee H. HilborneAffiliated withDepartment of Pathology and Center for Patient Safety, David Geffen School of Medicine at the University of California at Los Angeles
  • , Eugene M. SpiritusAffiliated withDepartment of Medicine, University of California at Irvine
  • , Gregory B. SeymannAffiliated withDepartment of Medicine, University of California at San Diego
  • , Craig R. KeenanAffiliated withDepartment of Medicine, University of California at Davis
  • , Kaveh G. ShojaniaAffiliated withOttawa Health Research Institute, University of Ottawa
  • , Marjorie Kagawa-SingerAffiliated withDepartment of Community Health Sciences, UCLA School of Public Health
  • , Neil S. WengerAffiliated withDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California at Los AngelesUCLA Healthcare Ethics Center

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Abstract

Background

Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed.

Objective

To understand the discrepancy between patients’ expectations and physicians’ behavior concerning error disclosure.

Design, Setting, and Participants

We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses.

Approach

Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators.

Results

Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to “connect the dots.” Descriptions involving nondisclosure of harmful errors were uncommon.

Conclusions

Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.

KEY WORDS

error disclosure ethics medical mistakes patient/doctor communication