Patients' and Physicians' Attitudes Regarding the Disclosure of Medical Errors

Abstract

Context Despite the best efforts of health care practitioners, medical errors are inevitable. Disclosure of errors to patients is desired by patients and recommended by ethicists and professional organizations, but little is known about how patients and physicians think medical errors should be discussed. Objective To determine patients' and physicians' attitudes about error disclosure. Design, Setting, and Participants Thirteen focus groups were organized, including 6 groups of adult patients, 4 groups of academic and community physicians, and 3 groups of both physicians and patients. A total of 52 patients and 46 physicians participated. Main Outcome Measures Qualitative analysis of focus group transcripts to determine the attitudes of patients and physicians about medical error disclosure; whether physicians disclose the information patients desire; and patients' and physicians' emotional needs when an error occurs and whether these needs are met. Results Both patients and physicians had unmet needs following errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Physicians agreed that harmful errors should be disclosed but "choose their words carefully" when telling patients about errors. Although physicians disclosed the adverse event, they often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Patients also desired emotional support from physicians following errors, including an apology. However, physicians worried that an apology might create legal liability. Physicians were also upset when errors happen but were unsure where to seek emotional support. Conclusions Physicians may not be providing the information or emotional support that patients seek following harmful medical errors. Physicians should strive to meet patients' desires for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors.

Apologies and Medical Error

“…Gallagher and colleagues [13] found patients desire and expect to be informed promptly about a medical error; to be given information about what occurred, why and how it occurred, how their health will be affected, and what steps will be taken to prevent future harm; and to receive an apology that signals a sense of regret and a desire to do better going forward. Indeed, they found ''[m]any patients said they would be less upset if the physician disclosed the error honestly and compassionately and apologized… [and]…that explanations of the error that were incomplete or evasive would increase their distress'' [13]. Patients also prefer that such communication occur without a need for prompting on their part [13].…”

“…Indeed, they found ''[m]any patients said they would be less upset if the physician disclosed the error honestly and compassionately and apologized… [and]…that explanations of the error that were incomplete or evasive would increase their distress'' [13]. Patients also prefer that such communication occur without a need for prompting on their part [13].…”

Nurses' experiences with errors in nursing

“…After being involved in an error, many nurses neither received the support they needed nor knew where to find such support (Scott et al, 2009;Waterman et al, 2007). Most health care institutions did not have 18 adequate support systems in place to assist staff with coping and adapting after an error (Gallagher et al, 2003;Schwappach & Boluarte, 2008).…”

"I'm Sorry" Laws and Medical Liability

“…Medical malpractice premiums have skyrocketed in recent years, most significantly in specialties such as obstetrics-gynecology and neurosurgery, and as a result many physicians fear that every patient is a potential litigant [2]. Two national surveys designed to assess attitudes toward disclosure revealed that fear of litigation was the primary reason for both physicians' and hospitals' reluctance to disclose errors and unanticipated outcomes [3,4].…”