Quality/Patient Safety

Physicians say they favor disclosure of medical errors to patients and families, but disclosure often does not occur

Ethical and professional guidelines make clear that physicians have a responsibility to disclose medical errors. Although physicians agree that patients should be informed about medical errors, many do not disclose errors to patients, according to a recent review of studies on the topic. The review was 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). The researchers examined in detail the results of studies described in 17 articles that were culled from over 800 articles reviewed on the disclosure of medical errors to patients and families.

In one survey of U.S. physicians, 77 percent responded that physicians should be required to tell patients when errors are made in their care. Focus group discussions found patients were unanimous in their desire to be told about any error that caused harm. Yet, in a recent national survey, only one-third of those who had experienced an error in their care or the care provided to a family member had been told of the error by the health care professional involved. In another study describing a vignette of a medication error that resulted in death, only half of physicians indicated that they would admit the error.

In response to a national survey, hospital risk managers reported that the most common elements of the disclosure process were explanations (92 percent), an undertaking to investigate the incident (87 percent), an apology (68 percent), and an acknowledgment of harm (66 percent). Less frequently reported were offering to share the results of the investigation (41 percent) and assuming responsibility for harm (33 percent). Physician fear of litigation is a significant obstacle to disclosure. In addition, physicians may anticipate patient distress, loss of patients, damage to their reputation, license revocation, loss of privileges, and other consequences. There is scant evidence on the positive and/or negative outcomes of medical error disclosure.

Details are in "Communicating with patients about medical errors," by Kathleen M. Mazor, Ed.D., Steven R. Simon, M.D., and Jerry H. Gurwitz, M.D., in the August 2004 Archives of Internal Medicine 164, pp. 1690-1697.

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