Doctors more likely to tell when patient knows error

Physicians in the United States and Canada generally report that they support disclosing medical errors to patients, but they have widely varying positions on when and how they would tell patients an error had occurred, according to recent work by Thomas H. Gallagher, MD, a researcher at the University of Washington School of Medicine in Seattle.1,2

In many cases, the physician is likely to disclose the error only if the patient already knows something went wrong.

In a survey of 2,637 physicians from various specialties, the researchers presented the physicians with one of four scenarios involving a medical error. Two of the scenarios were tailored to internal medicine specialists, and two were tailored to surgeons. One of each type of error would be apparent to the patient, and the others would not be apparent to the patient if he or she was not informed.

For instance, the more apparent surgical error involved a sponge left inside a patient's body and the less apparent surgical error involved an internal injury that a surgeon inflicted because of unfamiliarity with a new surgical tool. The physicians answered a series of questions about the scenario they received, including how likely they would be to disclose the error, what information they would convey if they did disclose the error, how serious the error was, and how likely it was to result in a lawsuit.

Eighty-five percent of the physicians agreed that the error they received was serious, and 81% believed the physician was very or extremely responsible for the error. Overall, 65% would definitely disclose the error, 29% would probably disclose, 4% would disclose only if the patient asked and 1% would definitely not disclose. The language the physicians would use also varied widely. Forty-two percent would use the word "error," 56% would mention the adverse event but not the error, 50% would give the patient specific information about what the error was, and 13% would not reveal any details not requested by the patient.

Surgeons more likely to disclose

Specialty and the nature of the error affected how likely the physicians were to disclose the error. Surgeons were more likely than other physicians to say they would definitely disclose the error (81% vs. 54%) but also reported that they would disclose less information. Thirty-five percent of surgeons and 61% of other physicians said they would disclose specific details about the error.

Those who received the more apparent errors were more likely to say they would disclose them than those who received the less apparent errors (81% vs. 50%) and would also disclose more information about them. Fifty-one percent of those who received the more apparent errors would use the word "error," vs. 32% of the other group.

"Some dimensions of errors might justify disclosing less information, such as if the error caused only trivial harm," the authors wrote. "However, physicians agreed that all the scenarios represented serious errors. Basing disclosure decisions on whether the patient was aware of the error is not ethically defensible or consistent with standards such as those from the Joint Commission on Accreditation of Health Care Organizations."

References

1. Gallagher TH, Waterman AD, Garbutt, JM, et al. US and Canadian physicians' attitudes and experiences regarding disclosing errors to patients. Arch Intern Med 2006; 166:1,605-1,611.

2. Gallagher TH, Waterman AD, Garbutt, JM, et al. Choosing your words carefully: How physicians would disclose harmful medical errors to patients. Arch Intern Med 2006; 166:1,585-1,593.