Disclosure of medical errors
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
BACKGROUND: Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited.
OBJECTIVE: This study sought to determine whether full disclosure, an existing positive physician-patient relationship, an offer to waive associated costs, and the severity of the clinical outcome influenced patients’ responses to medical errors.
PARTICIPANTS: Four hundred and seven health plan members participated in a randomized experiment in which they viewed video depictions of medical error and disclosure.
DESIGN: Subjects were randomly assigned to experimental condition. Conditions varied in type of medication error, level of disclosure, reference to a prior positive physician-patient relationship, an offer to waive costs, and clinical outcome.
MEASURES: Self-reported likelihood of changing physicians and of seeking legal advice; satisfaction, trust, and emotional response.
RESULTS: Nondisclosure increased the likelihood of changing physicians, and reduced satisfaction and trust in both error conditions. Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition, but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition. Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact.
CONCLUSIONS: This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors. The clinical outcome also influences patients’ responses. The impact of an existing positive physician-patient relationship, or of waiving costs associated with the error remains uncertain.
- Kohn LT, Corrigan JM, Donaldson M, eds. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
- Mazor KM, Simon SR, Yood RA, et al. Health plan members’ views about disclosure of medical errors. Ann Intern Med. 2004;140:409–18.
- Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients and physicians attitudes regarding the disclosure of medical errors. JAMA. 2003;289:1001–7. CrossRef
- Blendon R, DesRoches CM, Brodie M, et al. Views of practicing physicians and the public on medical errors. N Engl J Med. 2002;347:1933–40. CrossRef
- Hobgood C, Peck CR, Gilbert B, Chappell K, Zou B. Medical errors-what and when: what do patients want to know? Acad Emerg Med. 2002;9:1156–61.
- Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996;156:2565–9. CrossRef
- Mizrahi T. Managing medical mistakes: ideology, insularity and accountability among internists-in-training. Soc Sci Med. 1984;19:135–46. CrossRef
- Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265:2089–94. CrossRef
- Lamb RM, Studdert DM, Bohmer RMJ, Berwick D, Brennan TA. Hospital disclosure practices: results of a national survey. Health Aff. 2003;22:73–83. CrossRef
- The Kaiser Family Foundation, Agency for Healthcare Research and Quality, Harvard School of Public Health. National Survey on Consumers’ Experiences with patient Safety and Quality Information. Summary and Chartpack. Available at: http://www.kff.org/kaiserpolls/7209.cfm. Accessed December 2, 2004.
- Baylis F. Errors in medicine: nurturing truthfulness. J Clin Ethics. 1997;8:336–40.
- Finkelstein D, Wu AW, Holtzman NA, Smith MK. When a physician harms a patient by a medical error: ethical, legal, and risk-management considerations. J Clin Ethics. 1997;8:330–5.
- Hebert PC. Disclosure of adverse events and errors in healthcare: an ethical perspective. Drug Safety. 2001;24:1095–104. CrossRef
- Hebert PC, Levin AV, Robertson G. Bioethics for clinicians: 23. Disclosure of medical error. Can Med Assoc J. 2001;164:509–13.
- Kapp MB. Legal anxieties and medical mistakes: barriers and pretexts. J Gen Intern Med. 1997;12:787–8. CrossRef
- Kapp MB. Medical mistakes and older patients: admitting errors and improving care. J Am Geriatr Soc. 2001;49:1361–5. CrossRef
- Liang BA. A system of medical error disclosure. Qual Safety Health Care. 2002;11:64–8. CrossRef
- May T, Aulisio MP. Medical malpractice, mistake prevention, and compensation. Kennedy Inst Ethics J. 2001;11:135–46. CrossRef
- Peterson LM, Brennan T. Medical ethics and medical injuries; taking our duties seriously. J Clin Ethics. 1990;1:207–11.
- Porto GG. Disclosure of medical errors: facts and fallacies. J Health Care Risk Manage. 2001;21:67–76.
- Rosner F, Berger JT, Kark P, Potash J, Bennett AJ. Disclosure and prevention of medical errors. Committee on Bioethical issues of the medical society of the state of New York. Arch Intern Med. 2000;160:2089–92. CrossRef
- Smith ML, Forster HP. Morally managing medical mistakes. Camb Q Health Care Ethics. 2000;9:38–53. CrossRef
- Thurman AE. Institutional responses to medical mistakes: ethical and legal perspectives. Kennedy Inst Ethics J. 2001;11:147–56. CrossRef
- Wu AW, Cavanaugh TA, McPhee SJ, Lo B, Micco GP. To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. J Gen Intern Med. 1997;12:770–5. CrossRef
- Kraman SS, Hamm G. Risk management: extreme honesty may be the best policy. Ann Intern Med. 1999;131:963–7.
- Schwappach DLB, Koek CM. What makes an error unacceptable? A factorial survey on the disclosure of medical errors. Int J Qual Health Care. 2004;16:317–26. CrossRef
- American Board of Internal Medicine. Final Report on the Patient Satisfaction Questionnaire Project. Washington, DC: American Board of Internal Medicine; 1989.
- Anderson L, Dedrick R. Development of the trust in physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67:1091–100.
- U.S. Census Bureau, Census Table DP-1. Profile of General Demographic Characteristics. Massachusetts: Worcester County; 2000. Available at: http://censtats.census.gov/data/ma/05025027.pdf. Access confirmed January 31, 2005.
- Mazor KM, Simon SR, Gurwitz JH. Communicating with patients about medical errors: a review of the literature. Arch Intern Med. 2004;164:1690–7. CrossRef
- Kachalia A, Shojania KG, Hofer TP, Piotrowski M, Saint S. Does full disclosure of medical errors affect malpractice liability? Jt Comm J Qual Improv. 2003;29:503–11.
- Hickson GB, Clayton EW, Githens PB, Sloan FA. Factors that prompted families to file medical malpractice claims following perinatal injuries. JAMA. 1992;267:1359–63. CrossRef
- Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994;154:1365–70. CrossRef
- Vincent CA, Pincus T, Scurr JH. Patients’ experience of surgical accidents. Qual Health Care. 1993;2:77–82. CrossRef
- Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994;343:1609–13. CrossRef
- Levinson W, Roter DL, Mullooly JP, et al. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9. CrossRef
- Ambady N, Laplante D, Nguyen T, Rosenthal R, Chaumeton N, Levinson W. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002;132:5–9. CrossRef
- Disclosure of medical errors
Journal of General Internal Medicine
Volume 21, Issue 7 , pp 704-710
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical error
- physician-patient relationship
- compensation and redress
- Industry Sectors
- Author Affiliations
- 1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA, USA
- 2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- 3. Fallon Clinic, Worcester, MA, USA