Original Articles

Journal of General Internal Medicine

, Volume 21, Issue 7, pp 704-710

First online:

Disclosure of medical errors

What factors influence how patients respond?
  • Kathleen M. MazorAffiliated withMeyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health PlanDepartment of Medicine, University of Massachusetts Medical School Email author 
  • , George W. ReedAffiliated withDepartment of Medicine, University of Massachusetts Medical School
  • , Robert A. YoodAffiliated withMeyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health PlanDepartment of Medicine, University of Massachusetts Medical SchoolFallon Clinic
  • , Melissa A. FischerAffiliated withMeyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health PlanDepartment of Medicine, University of Massachusetts Medical School
  • , Joann BarilAffiliated withMeyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan
  • , Jerry H. GurwitzAffiliated withMeyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health PlanDepartment of Medicine, University of Massachusetts Medical School

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Abstract

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.

Key words

medical error disclosure physician-patient relationship compensation and redress