Disclosing Medical Errors to Patients: Attitudes and Practices of Physicians and Trainees
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Disclosing errors to patients is an important part of patient care, but the prevalence of disclosure, and factors affecting it, are poorly understood.
To survey physicians and trainees about their practices and attitudes regarding error disclosure to patients.
DESIGN AND PARTICIPANTS
Survey of faculty physicians, resident physicians, and medical students in Midwest, Mid-Atlantic, and Northeast regions of the United States.
Actual error disclosure; hypothetical error disclosure; attitudes toward disclosure; demographic factors.
Responses were received from 538 participants (response rate = 77%). Almost all faculty and residents responded that they would disclose a hypothetical error resulting in minor (97%) or major (93%) harm to a patient. However, only 41% of faculty and residents had disclosed an actual minor error (resulting in prolonged treatment or discomfort), and only 5% had disclosed an actual major error (resulting in disability or death). Moreover, 19% acknowledged not disclosing an actual minor error and 4% acknowledged not disclosing an actual major error. Experience with malpractice litigation was not associated with less actual or hypothetical error disclosure. Faculty were more likely than residents and students to disclose a hypothetical error and less concerned about possible negative consequences of disclosure. Several attitudes were associated with greater likelihood of hypothetical disclosure, including the belief that disclosure is right even if it comes at a significant personal cost.
There appears to be a gap between physicians’ attitudes and practices regarding error disclosure. Willingness to disclose errors was associated with higher training level and a variety of patient-centered attitudes, and it was not lessened by previous exposure to malpractice litigation.
KEY WORDSmedical errors error disclosure medical ethics professionalism doctor–patient relationships malpractice litigation
Preliminary and partial data from this study were presented at the Society of General Internal Medicine’s 29th Annual Meeting in Los Angeles and have been published as an abstract [Journal of General Internal Medicine 2006;21(S4):36]. This study was funded by the Robert Wood Johnson Foundation’s Generalist Physician Faculty Scholars Program, through a grant to Dr. Kaldjian (grant # 45446). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Conflicts of Interest
- 4.American Board of Internal Medicine, American College of Physicians–American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243–6.Google Scholar
- 5.AMA Council on Ethical and Judicial Affairs. Code of Medical Ethics: Current Opinions with Annotations (Opinion 8.12). Chicago, IL: American Medical Association; 1998. Available at http://www.ama-assn.org/ama/pub/category/2498.html. Accessed April 24, 2006.Google Scholar
- 9.Gallagher TH, Lucas MH. Should we disclose harmful medical errors to patients? If so, how? J Clin Outcomes Manag. 2005;12:253–9.Google Scholar
- 15.Gallagher TH, Garbutt JM, Waterman AD, Flum DR, Larson EB, Waterman BM, Dunagan WC, Faser VJ, Levinson W. Choosing your words carefully: how physicians would disclose harmful medical errors to patients. Arch Intern Med. 2006:1585–93.Google Scholar
- 18.Weber DO. Who’s sorry now? Physician Exec. 2006;32:6–14.Google Scholar
- 22.Standard RI. 2.90. 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). Oak Brook, IL: Joint Commission Resources; 2005.Google Scholar
- 28.Nunnally JC, Bernstein IH. Psychometric Theory (3rd Ed.). New York, NY: McGraw-Hill; 1994.Google Scholar
- 35.Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.Google Scholar
- 41.Leape LL. Understanding the power of apology: how saying “I’m sorry” helps heal patients and caregivers. Focus Patient Saf. 2005;8:1–3. Available at http://www.npsf.org/download/Focus2005Vol8No4.pdf. Accessed April 24, 2006.
- 43.Flynn E, Jackson JA, Lindgren K, Moore C, Poniatowski L, Youngberg B. Shining the light on errors: How open should we be? Oak Brook, IL: University HealthSystem Consortium; 2002.Google Scholar