Feature Story

Surgeons vary widely in their approaches to disclosing medical errors to their patients

Surgeons are encouraged to fully disclose medical errors they make during the care of patients, yet few receive training on the best way to talk to patients about errors. Surgeons are also often reluctant to do so because of possible malpractice suits, discomfort in facing angry patients, and concern about potential damage to their reputation. A study, supported in part by the Agency for Healthcare Research and Quality (HS11898 and HS14012), analyzed how surgeons talk with patients about medical errors and found that the surgeons' approaches to these discussions varied widely.

Researchers randomly assigned 30 surgeons to meet with standardized patients (SPs), who portrayed patients in 3 different hypothetical error scenarios. The scenarios included a wrong-side lumpectomy related to a surgeon's error in labeling breast biopsy specimens, a retained surgical sponge after a splenectomy, and life-threatening hyperkalemia-induced cardiac arrhythmia related to the surgeon forgetting to check laboratory test results. The SPs, who had experience in assessing physicians' communication skills, rated each encounter based on five communication elements of effective error disclosure.

The surgeons were rated highest on their ability to explain the medical facts about the errors (average scores for the three scenarios ranged from 3.93 to 4.20 out of a maximum score of 5). However, surgeons used the word "error" or "mistake" in only 57 percent of disclosure conversations. In 27 percent of cases, surgeons used the words "complication" or "problem" to describe the error.

The average scores for surgeons when rated for honesty and truthfulness ranged from 3.58 to 4.13. For empathy, surgeons averaged scores ranging from 3.58 to 3.83. Surgeons scored the lowest on prevention of future errors: 1.75 to 2.40.

Surgeons admitted full responsibility for the error in 65 percent of cases, verbally apologized in 47 percent, and acknowledged or validated the patient's emotions in 55 percent. Eight percent of surgeons discussed how similar errors would be prevented in the future, and 20 percent offered to refer the patient to another doctor for a second opinion or transfer of care.

See "How surgeons disclose medical errors to patients: A study using standardized patients," by David K. Chan, M.D., Thomas H. Gallagher, M.D., Richard Reznick, M.D., and Wendy Levinson, M.D., in the November 2005 Surgery 138, pp. 851-858.

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