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Disclosing Medical Errors to Patients: It’s Not What You Say, It’s What They Hear

  • Albert W. Wu
  • I-Chan Huang
  • Samantha Stokes
  • Peter J. Pronovost
Original Article

ABSTRACT

BACKGROUND

There is consensus that patients should be told if they are injured by medical care. However, there is little information on how they react to different methods of disclosure.

OBJECTIVE

To determine if volunteers’ reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility.

DESIGN

Survey of viewers randomized to watch videos of disclosures of three adverse events (missed mammogram, chemotherapy overdose, delay in surgical therapy) with designed variations in extent of apology (full, non-specific, none) and acceptance of responsibility (full, none).

PARTICIPANTS

Adult volunteer sample from the general community in Baltimore.

MEASUREMENTS

Viewer evaluations of physicians in the videos using standardized scales.

RESULTS

Of 200 volunteers, 50% were <40 years, 25% were female, 80% were African American, and 50% had completed high school. For designed variations, scores were non-significantly higher for full apology/responsibility, and lower for no apology/no responsibility. Perceived apology or responsibility was related to significantly higher ratings (chi-square, 81% vs. 38% trusted; 56% vs. 27% would refer, p < 0.05), but inclination to sue was unchanged (43% vs. 47%). In logistic regression analyses adjusting for age, gender, race and education, perceived apology and perceived responsibility were independently related to higher ratings for all measures. Inclination to sue was reduced non-significantly.

CONCLUSIONS

Patients will probably respond more favorably to physicians who apologize and accept responsibility for medical errors than those who do not apologize or give ambiguous responses. Patient perceptions of what is said may be more important than what is actually said. Desire to sue may not be affected despite a full apology and acceptance of responsibility.

KEY WORDS

medical error disclosure apology video patient perceptions vignette 

Notes

Acknowledgments

This research was supported by grants from MCIC Vermont and the Agency for Healthcare Research and Quality (AHRQ), grant no. U18 H511902-01. The authors have no conflicts of interest.

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Albert W. Wu
    • 1
    • 2
  • I-Chan Huang
    • 3
  • Samantha Stokes
    • 4
  • Peter J. Pronovost
    • 1
    • 5
  1. 1.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Epidemiology and Health Policy ResearchUniversity of Florida College of MedicineGainesvilleUSA
  4. 4.WashingtonUSA
  5. 5.Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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