Disclosing Medical Errors to Patients: It’s Not What You Say, It’s What They Hear
- 811 Downloads
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.
To determine if volunteers’ reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility.
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).
Adult volunteer sample from the general community in Baltimore.
Viewer evaluations of physicians in the videos using standardized scales.
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.
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 WORDSmedical error disclosure apology video patient perceptions vignette
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.
- 1.American College of Physicians Ethics Manual. Philadelphia 1992.Google Scholar
- 2.American Medical Association Council on Ethical and Judicial Affairs. Code of medical ethics, annotated current opinions. 2004–2005 ed. Chicago: American Medical Association.Google Scholar
- 3.Lo B. Resolving Ethical Dilemmas: A Guide for Clinicians, 2nd ed. Lippincott: Williams and Wilkins, Philadelphia; 2000.Google Scholar
- 6.AHA Management Advisory. Ethical conduct for health care institutions. Chicago: American Hospital Association; 1992.Google Scholar
- 7.Leape LL. Full disclosure and apology – an idea whose time has come. Physician Exec. 2006;32(2):16–8.Google Scholar
- 8.American Society for Healthcare Risk Management of the American Hospital Association. Disclosure of unanticipated events: the next step in better communication with patients. Chicago; 2003.Google Scholar
- 9.Institute of Medicine (UA) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington: Naitonal Academy Press; 2001.Google Scholar
- 11.Joint Commission Standard RI. 1.2.2. Revisions to Joint Commission Standards in Support of Patient Safety and Medical/Health Care Error. July 1, 2001. http://www.dcha.org/JCAHORevision.htm Accessed 5 May 2009.
- 17.NHS National Patient Safety Agency. Safer practice notice: Being open when patients are harmed. 15 September 2005. http://www.npsa.nhs.uk/nrls/alerts-and-directives/notices/disclosure/ Accessed 5 May 2009.
- 19.xGallagher TH, Denham CR, Leape LL, Amori G, Levinson W. National Quality Forum safe practice. Commentary: Disclosing unanticipated outcomes to patients: the art and practice. J Patient Saf. 2007;3:158–65.Google Scholar
- 26.Schoen C, Osborn R, Huynh PT, Doty M, Zapert K, Peugh J, et al. Taking the pulse of health care systems: Experiences of patients with health problems in six countries. Health Aff (Millwood). 2005; W5: 509–525. Suppl Web Exclusives.Google Scholar
- 38.Nunnaly JC, Bernstein IH. Psychometric theory,. 3rd ed. New York: McGraw-Hill; 1994.Google Scholar
- 39.Dayton E, Henriksen K. Teamwork and communication: communication failure: basic components, contributing factors, and the call for structure. Jt Comm J Qual and Patient Safety. 2007;33(1):34–47.Google Scholar
- 47.Barter C, Renold E. The use of vignettes in qualitative research. Social Research Update. 1999;25:1–4.Google Scholar