Patient Safety/Quality

Doctors' disclosure of medical errors improves patient satisfaction but may not prevent legal action

Although guidelines recommend that doctors disclose medical errors that have resulted in patient injury, they often do not. Full disclosure reduces the likelihood that patients will change doctors and generates greater patient satisfaction and trust. However, it doesn't always dissuade patients from taking legal action, concludes a study supported in part by the Agency for Healthcare Research and Quality through the Centers for Education and Research on Therapeutics (CERTs) program (HS10391 and HS11843).

Investigators at the HMO Research Network CERT used a mailed questionnaire to examine how the type of medical error, clinical severity of the error, and level of disclosure affected responses of 958 members of one health maintenance organization. Each questionnaire included a vignette describing a medical error (failure to check for penicillin allergy or inadequate monitoring of antiepileptic medication); an associated clinical outcome (life-threatening or less serious); and a physician-patient dialogue, with either full disclosure (acceptance of responsibility and an apology) or nondisclosure (expression of regret without acceptance of responsibility or an apology).

Full disclosure reduced the reported likelihood of seeking legal advice in only one vignette (missed allergy error and serious clinical outcome). In other vignettes, a high percentage of patients said that they would seek legal advice, even with full disclosure. Overall, nondisclosure, life-threatening outcome, and the inadequate monitoring error were all associated with a higher likelihood of seeking legal advice. Almost all respondents (99 percent) wanted to be told of errors, most (83 percent) favored financial compensation if harm occurred, and few (13 percent) favored compensation if no harm occurred.

See "Health plan members' views about disclosure of medical errors," by Kathleen M. Mazor, Ed.D., Steven R. Simon, M.D., Robert A. Yood, M.D., and others, in the March 16, 2004, Annals of Internal Medicine 140(6), pp. 409-418.

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