Health Plan Members' Views about Disclosure of Medical Errors

Abstract

Patients will probably respond more favorably to physicians who fully disclose medical errors than to physicians who are less forthright, but the specifics of the case and the severity of the clinical outcome also affect patients' responses. In some circumstances, the desire to seek legal advice may not diminish despite full disclosure.

Disclosure-And-Resolution Programs That Include Generous Compensation Offers May Prompt A Complex Patient Response

“…[11][12][13][14][15][16][17] Yet one key policy question-whether pairing disclosure or apology with compensation offers improves outcomes of disclosure or apology for medical injuries-is largely unexplored. Of the two studies we identified that asked respondents to predict their response to disclosures and offers, one did not isolate the effect of the compensation offer, 18 and one considered only a medical-expenses offer.…”

Apologies and Medical Error

“…This ranged from a simple acknowledgement of the error to various forms of apology'' [58]. In a similar survey, Mazor and colleagues [39] found most (88%) of the surveyed members of a healthcare plan ''would want the doctor to tell [them] that he or she was sincerely sorry.'' Focus groups with patients have indicated similar preferences.…”

“…For example, in several studies, Mazor and her colleagues [38,39] asked members of a healthcare plan to take the role of a patient and to indicate how they would respond to an injury caused by medical error. They found patients were less likely to indicate they would seek legal advice when the physician assumed responsibility for the error, apologized, and outlined steps that would be taken to prevent recurrence [38,39]. Similarly, Witman and colleagues [58] found patients were less likely to indicate they would file a lawsuit if they were informed of an error than if they were not informed.…”

“…Similarly, apologies influence estimates of the likelihood that the injury-producing scenario will recur; the apology is interpreted as a signal that steps will be taken to avoid similar consequences in the future [16,44,46]. Apologies also have positive effects on expectations and intentions for a future relationship between the parties [38,39,44,46], play a role in restoring trust [38,39], reduce negative emotional reactions such as anger [16,44,46,51], induce favorable physiological responses in both parties [59], and reduce antagonistic responses [16,42,44,46].…”

On Patient Safety: Do You Say “I'm Sorry” to Patients?

“…''When you look across populations of patients, apologizing makes it less likely that patients will sue you, and it makes it easier to resolve those lawsuits that do get filed.'' This is certainly no guarantee, but studies have suggested that full disclosure to patients is associated with lower likelihood of changing physicians, higher satisfaction, greater trust, a more positive emotional response, and less support for sanctions against the physician [7,9]. The University of Michigan ''open disclosure with offer'' approach to patient injuries and malpractice claims was implemented in 2004 and has resulted in dramatically decreased costs associated with liability, compensation, and legal fees [2].…”