Doctors believe in error disclosure, just don't do it

Disclosure to patients appears easier than to hospital

Doctors appear to disclose actual medical errors to their hospitals at a lower rate than their views on disclosure would indicate, according to a University of Iowa researcher.

Information from the study,1 along with a companion study released in 2007,2 was based on surveys of doctors in teaching hospitals and shows an apparent disconnect between error disclosure to patients and error reporting to hospitals and points to the need for a more integrated view of medical error communication, says researcher Lauris Kaldjian, MD, PhD, director of the program in biomedical ethics and medical humanities at the University of Iowa Carver College of Medicine.

For example, 41% of physicians in the 2007 study said they actually had disclosed a minor error to a patient, but only 18% of physicians in the current study said they had reported a minor error to their hospital. And it wasn't for lack of opportunity: 19% acknowledged in the 2007 study having made a minor medical error and not disclosing it.

"Taken together, the findings indicate that physicians have more experience talking to patients about medical errors than reporting them to hospitals," says Kaldjian.

"It may be that physicians find it more important or meaningful to talk to patients about mistakes and may not see as much value in communicating the same mistakes to a reporting system," he adds.

Kaldjian points out that disclosing errors to patients relates directly to real-time patient care, while reporting errors to institutions is directed toward improving the care of future patients. "It is important that we try to find a way to accomplish both kinds of error communication," he suggests.

Kaldjian and co-investigators received survey responses from 338 physician participants from different regions in the United States. Among them, 73% said they would report to their institution a hypothetical error resulting in minor harm, and 92% said they would report a hypothetical error resulting in major harm. However, few physicians have actually reported a minor error (18%) or a major error (4%) to their hospital. Likewise, 17% acknowledged not reporting an actual minor error and 4% acknowledged not reporting an actual major error.

The discrepancy between attitude and action is particularly notable, Kaldjian says, given that the survey showed that 84% of physicians believe error reporting can improve the quality of care.

The answer to the gap may lie partly in other findings from the survey, he notes: Only 55% said they knew how to report errors, and only 39% knew what kinds of errors to report.

"The fact that nearly every physician is likely to make a minor error at some point in his or her career, taken together with the lack of understanding on how and what to report, indicates we need to clarify what errors should be reported and how to report them," he concludes.

Half the respondents said they would report errors if they knew they would receive feedback, and individuals who had been involved in malpractice cases were not less likely to report hypothetical errors.

"We should also recognize that a physician's willingness to be straightforward about errors depends on their beliefs about errors and the value of error communication, so we should think creatively about ways to encourage clinicians to draw upon the personal and professional commitments that can motivate error reporting in the midst of countervailing pressures," Kaldjian suggests.

References

  1. Kaldjian LC, Jones EW, Wu BJ, et al. Reporting medical errors to improve patient safety: a survey of physicians in teaching hospitals. Arch Intern Med 2008;168:40-46.
  2. Kaldjian LC, Jones EW, Wu BJ. Disclosing medical errors to patients: Attitudes and practices of physicians and trainees. J Gen Intern Med 2007;22:988-996.

Source

For more information, contact:

  • Lauris Kaldjian, MD, PhD, director, program in biomedical ethics and medical humanities, University of Iowa Carver College of Medicine, Iowa City. E-mail: lauris-kaldjian@uiowa.edu.