How you can encourage doctors to disclose errors
To encourage physicians to fully disclose errors, health care risk managers must understand that the adverse event can place the doctor in what feels like an untenable situation, says John Banja, PhD, assistant director for health sciences and clinical ethics at Emory University in Atlanta and an expert on applying ethical principles in risk management.
"Disclosing an adverse event puts the physician an extreme dilemma of duty vs. inclination," he explains. "He or she says, 'My duty requires me to do this,' but the inclination is to protect yourself, and every physician will fear that disclosing puts you and your career at risk."
The following suggestions were offered by Banja and Lauris Kaldjian, MD, PhD, associate professor of internal medicine in the University of Iowa Roy J. and Lucille A. Carver College of Medicine and director of the college's program in biomedical ethics and medical humanities:
- Don't assume that the doctor looks at the situation in the same way you do. Risk managers and other involved parties may see the incident as just another adverse event — unfortunate yes, but something to handle just as you handle all the others. But for the physician involved, the incident may be personally devastating, Banja says. It is not just a work issue that can be addressed and forgotten.
- Remind them that, deep down, they want do to the right thing. "Tap into how they felt when they were leaving medical school, that idealism and enthusiasm for providing the best care to the patient," Kaldjian says. "Point out that making an error doesn't negate that. They can still do the right thing by informing the patient properly."
- Pretend for a moment that there is no risk of a malpractice lawsuit. When you stop focusing so much on that concern, you can see that there still are plenty of other issues still troubling the physician, Kaldjian says.
- Offer continuing education for physicians that shows the true relationship between disclosure and malpractice liability. Many physicians assume that disclosing an error increases the chance of being sued, but the research has proven otherwise, Banja notes.
- Acknowledge that the physician probably is worried about being reported to the National Practitioner Data Bank. This is a major concern for most physicians, who may fear this even more than being sued, Banja says. Explore the realities of whether this incident is a reportable, and whether the way it is handled after the fact has any effect on it being reported.
For more information on helping physicians disclose errors, contact:
- John Banja, PhD, Assistant Director for Health Sciences and Clinical Ethics, Emory University, 1462 Clifton Road N.E., Suite 302, Atlanta, GA 30322. Telephone: (404) 712-4804. E-mail: email@example.com.