73% of physicians discuss mistakes with colleagues

Doctors also need emotional support

Even with the driven culture of modern medicine, one study published recently in the Journal of Medical Ethics found that 73% of 338 respondents said that they usually discuss their mistakes with their colleagues.

The study's lead author is Lauris Kaldjian, MD, PhD, associate professor, division of internal medicine at the University of Iowa Carver School of Medicine, and director of that school's program in biomedical ethics and medical humanities, both in Iowa City, IA.

"Three-quarters of doctors said that they usually discuss their mistakes — that's evidence that . . . as physicians, our self-perception is that we are the kind of people who talk to our colleagues about our mistakes," Kaldjian tells Medical Ethics Advisor.

The study presented a hypothetical scenario of clinical error with the incorrect antibiotic being administered with three outcomes, with Outcome #1 being no harm; Outcome #2 having caused minor harm; and Outcome #3 having caused major harm.

With the outcomes going from no harm to major harm, the survey responses were 77%, 87%, and 94%.

"If that is a true representation of how physicians generally respond in these three different categories of errors based on their outcomes, I would find that encouraging, statistically speaking," Kaldjian says.

One of the authors' points made in the discussion is: "Discussions of medical errors by physicians will always be a challenging yet vital responsibility, one that cannot be avoided if we want to learn from our mistakes and receive support as we work through their implications.

"This responsibility derives from a commitment to respect our patients and our colleagues, and it is directed towards quality patient care and the integrity of the profession," the authors write.

Kaldjian described medical errors in teaching environments as a "vicarious resource." Not only that, he describes medical errors as a "precious resource," noting that if physicians choose not to share this resource, then they are "depriving" colleagues of something from which not only they, but their patients, could benefit.

"I think the good news here is that there is a very long history of discussing cases in health care to teach and discussing cases where things have not gone well or unexpectedly badly . . . ." Kaldjian says. "The question, I think, in my mind is: Is it sufficiently a part of our current traditions, or not?"

Individual vs. group sharing

One of the survey questions asked whether the respondent knew at least one colleague who would support him or her if he or she needed to discuss a medical mistake. Of those surveyed, 89% said yes.

Also, 70% of respondents said they believed that discussing mistakes strengthened professional relationships.

The "self-administered, paper-based" survey did not ask respondents whether they would be more likely to share their experience with a medical mistake individually or in a group setting.

There are some circumstances where group sharing is the goal, such as morbidity and mortality conferences, which are more frequent in surgical settings, Kaldjian says. Those "conferences" are designed so that physicians, meeting on perhaps a weekly or monthly basis, discuss the deaths and complications that have occurred with patients in their care.

When medical errors occur, especially in teaching hospitals, there is a "dual agenda that has to be considered," Kaldjian says.

"That is to say that the individual involved in the error needs two things: They need support from their colleagues, especially emotional support, and they also need education — they need learning," he says. "Especially, trainees need to learn from their errors."

One-on-one communication is more likely to fulfill the emotional needs of a physician, while a group setting is more likely to fulfill the teaching opportunities available when medical mistakes occur.

"It's less likely in my mind that you're going to get a group that's so exceptional that in the same setting . . . you can create an environment where there's learning, but also emotional support for the individual or the individuals involved," Kaldjian says.

Why physicians share their mistakes

Regarding attitudes toward errors, 91% of the survey respondents said they are motivated to discuss errors in order to learn whether a colleague "would have made the same clinical judgments and decisions I did."

Eighty percent of respondents said they were motivated to discuss errors with colleagues "to allow them to learn from my mistakes" 79% said they were motivated in order "to receive their support and understanding" while 60% responded positively "to unburden myself."

On the opposite side of this perspective, 27% indicated it would be hard for them to talk about their mistakes with colleagues because they thought it would "damage their reputation."

But Kaldjian suggests that role-modeling is important, especially in teaching environments, so that students are given the opportunity to see more experienced clinicians reveal and discuss their medical mistakes as learning opportunities. Interestingly, the study found that "having observed a more experienced clinician discuss a mistake makes you at least four times more likely to have tried to serve at least once as a role model by discussing an error."

Sixty-four percent of respondents agreed that "in my experience, physicians tend to expect perfect performance from each other." Likewise, 69% agreed with the statement that "competition in medical education and training encourages students and trainees to keep silent about their mistakes."

And finally, the study indicated that physicians believe they are their own worst critics when they make a mistake.

According to Kaldjian, there are "three directions of disclosure, and I think whenever an error occurs, the clinician involved should ask themselves at least three questions":

  • Should I disclose the error to the patient?
  • Should I report it to the hospital to increase patient safety?
  • Should I discuss it with a colleague?

Kaldjian says, "I think one way to help make sense [of these results] is that if we actually deal honestly with our fallability, we actually improve our excellence and make it less likely that we're going to make another mistake."

Reference

  1. Kaldjian, LC, et al. Do faculty and resident physicians discuss their medical errors? J. Med. Ethics 2008;34;717-722.

Source

For more information, contact:

  • Lauris C. Kaldjian, MD, PhD, Director, Program in Biomedical Ethics and Medical Humanities; Associate Professor, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. E-mail: Lauris-kaldjian@uiowa.edu.