Medical error disclosure: the gap between attitude and practice

Abstract

BackgroundThis study aims to evaluate the attending surgeons' and residents' attitudes towards error disclosure and factors that can potentially affect these tendencies in major academic hospitals affiliated with Tehran University of Medical Sciences (TUMS).Methods and materialIn a cross-sectional study, self-administered questionnaires were delivered to all attending surgeons and second to fourth year surgical residents of TUMS during October and November 2009. The questionnaire contained two clinical scenarios and questions regarding physicians' attitudes towards disclosing medical error and their actual practice in the case of their last error. Of the 63 distributed questionnaires, 53 (84.1%) were completed and returned.ResultsParticipants were less likely to disclose minor (39.6%; 21/53) than major (49.1%; 29/53) medical errors. Participants believed that their most important concerns for not disclosing errors were fear of a malpractice lawsuit (71.7%, n=38), losing patients' trust (62.3%, n=33), and emotional reactions of the patients and their relatives (56.6%, n=30). Although most physicians indicated they would disclose errors in minor and major scenarios, only 16.7% (n=8) had disclosed their last medical errors to their patients, two of which had resulted in patients taking legal action.ConclusionThere was an obvious gap between surgeons' intentions and actual practices concerning disclosure of medical error. Education in medical error management to professionally support error disclosure might help reduce the gap.

Ethical responsibility and treatment errors

“…As Ghalandarpoorattar et al showed, assigning blame to individuals is often the 'dominant culture in medical error management'. 5 This application of blame occurs despite the fact that the majority of adverse events arise due to multiple factors that no individual should be blamed for. 6 If the provider chooses to give a full disclosure, they may lose the support of the risk managers and insurers and put themselves in a position to have a lawsuit brought against him or her.…”

Nursing Interns’ Perception Regarding Patients’ Rights and Patients’ Advocacy

“…Moreover, [42] mention that physicians afraid to disclose errors due to their fear from mistrust of client and the psychological impact on the patients and their relatives.…”

Surgical complications: Disclosing adverse events and medical errors

“…Although physicians were willing to report hypothetical errors, the number of physicians who had reported an actual error was low. [4][5][6] Barriers to reporting errors included fear of litigation and system-based issues, such as lack of familiarity with how to report errors or lack of knowledge regarding what kinds of errors to report. In addition, physicians sometimes believed that the event was trivial or that disclosure would cause the patient and family more emotional distress without significant benefit; thus, they chose to withhold information from them.…”