Medical Errors—What and When: What Do Patients Want to Know?

Hobgood, Cherri; Peck, Clifford R.; Gilbert, Benjamin; Chappell, Kathryn; Zou, Bin

doi:10.1197/aemj.9.11.1156

Cited by 91 publications

(22 citation statements)

References 14 publications

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“…An important finding of our study is that 35.5% of respondents preferred to be informed of near miss ME. This is a much smaller percentage than the 88-92% reported in previous studies [15,27]. Interestingly, our study also showed that 30.4% of respondents perceived that the norm is to disclose near miss ME.…”

Section: Discussioncontrasting

confidence: 77%

“…The American Society for Reproductive Medicine states that if there is clearly no adverse effect of a ME, disclosure may not be obligatory if it may unnecessarily increase patient's stress [26]. In the few empirical studies that have specifically addressed near miss ME, 88% to 92% of patients desired disclosure [15,27]. In contrast, most physicians opposed near miss ME disclosure [5].…”

Section: Introductionmentioning

confidence: 99%

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Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice

2010

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BackgroundDisclosure of near miss medical error (ME) and who should disclose ME to patients continue to be controversial. Further, available recommendations on disclosure of ME have emerged largely in Western culture; their suitability to Islamic/Arabic culture is not known.MethodsWe surveyed 902 individuals attending the outpatient's clinics of a tertiary care hospital in Saudi Arabia. Personal preference and perceptions of norm and current practice regarding which ME to be disclosed (5 options: don't disclose; disclose if associated with major, moderate, or minor harm; disclose near miss) and by whom (6 options: any employee, any physician, at-fault-physician, manager of at-fault-physician, medical director, or chief executive director) were explored.ResultsMean (SD) age of respondents was 33.9 (10) year, 47% were males, 90% Saudis, 37% patients, 49% employed, and 61% with college or higher education. The percentage (95% confidence interval) of respondents who preferred to be informed of harmful ME, of near miss ME, or by at-fault physician were 60.0% (56.8 to 63.2), 35.5% (32.4 to 38.6), and 59.7% (56.5 to 63.0), respectively. Respectively, 68.2% (65.2 to 71.2) and 17.3% (14.7 to 19.8) believed that as currently practiced, harmful ME and near miss ME are disclosed, and 34.0% (30.7 to 37.4) that ME are disclosed by at-fault-physician. Distributions of perception of norm and preference were similar but significantly different from the distribution of perception of current practice (P < 0.001). In a forward stepwise regression analysis, older age, female gender, and being healthy predicted preference of disclosure of near miss ME, while younger age and male gender predicted preference of no-disclosure of ME. Female gender also predicted preferring disclosure by the at-fault-physician.ConclusionsWe conclude that: 1) there is a considerable diversity in preferences and perceptions of norm and current practice among respondents regarding which ME to be disclosed and by whom, 2) Distributions of preference and perception of norm were similar but significantly different from the distribution of perception of current practice, 3) most respondents preferred to be informed of ME and by at-fault physician, and 4) one third of respondents preferred to be informed of near-miss ME, with a higher percentage among females, older, and healthy individuals.

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Section: Discussioncontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice

2010

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“…Most medical professionals felt that DPSI is unnecessary in the case of near misses [17,22,28-32], but most of the general public believed the opposite [77]. Hearing about the occurrence of a near miss could upset patients, but it would alert patients to the type of medical errors that they should be cautious about and would reassure them that the medical systems designed to keep them safe were working [39].…”

Section: Discussionmentioning

confidence: 99%

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

Ock

Lim

et al. 2017

J Prev Med Public Health

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ObjectivesWe performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI).MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them.ResultsThere was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI.ConclusionsThe reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

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“…Experts advocate that the initial disclosure discussion with the patient and their support person should occur as soon as possible after recognition of the adverse event ( 16 , 37 , 49 , 50 ). A delay in disclosure breeds uncertainty and evokes anxiety for the patient, support person(s), and their health care team.…”

Section: Acknowledging Complicationsmentioning

confidence: 99%

Complications: acknowledging, managing, and coping with human error

Helo¹,

Moulton²

2017

Transl. Androl. Urol.

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Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on a tremendous sense of responsibility for the care of their patients, and often bear the burden of their mistakes in isolation. Physicians may struggle with guilt, shame, and a crisis of confidence, which may thwart efforts to identify areas for improvement that can lead to meaningful change. Coping strategies for providers include discussing the event with others, seeking professional counseling, and implementing quality improvement projects. Physicians and health care organizations need to find adaptive ways to deal with complications that will benefit patients, providers, and their institutions.

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Medical Errors—What and When: What Do Patients Want to Know?

Cited by 91 publications

References 14 publications

Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice

Which medical error to disclose to patients and by whom? Public preference and perceptions of norm and current practice

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

Complications: acknowledging, managing, and coping with human error

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