Hasty disclosure can damage other providers

Tertiary care providers can be so influenced by seeing the end results of a supposed error — the patient's condition is worsened — that they make overly harsh judgments about the previous provider's care, says Matson Sewell, MS, MPH, CPHRM, principal with Matson Sewell Healthcare Consulting in Sacramento, CA. Those judgments can cause serious damage to the hospitals.

What seems to be an error or substandard care should be judged not with perfect hindsight but in light of what information was available to the provider at that time, Sewell says. "That's the mistake that I see people make: an assumption of error without investigating whether an error really occurred," she says. "I'm afraid a lot of tertiary care facilities do have a certain amount of professional arrogance with respect to the community hospitals' care."

The provider that discovers the error can assume it is doing the right thing by immediately informing the patient, but that self-satisfaction can come at a price. Rushing to disclose a supposed error to the patient, without first confirming that the other hospital truly was at fault, can damage your relationship with that hospital, Sewell cautions. "Unfortunately what I see usually happen, and around Boston this is almost epidemic, the provider basically criticizes the care of the referring hospital, never even tells that hospital there was even a concern, and that is taking professional potshots from a distance," she says. "It does cause problems. In small communities you have to work and shop and go to PTA meetings with the doctor you're criticizing, so you just want to be sure about what you're saying."

Sewell also points out that disclosing a provider's error might lead to a legal claim, and the doctor who discovered it might be called as an expert witness. This is not reason to avoid disclosing a true error, but it is reason to avoid being overly judgmental about the other provider's care or too hasty with disclosure, she says.

"The other thing to know is that if litigation is initiated, your own care will come into scrutiny," Sewell says. "I've seen cases in which the disclosing physician ended up being the primary defendant, not the person whose error he disclosed, and the plaintiff was awarded damages."