Health Care Quality/Patient Safety

Fear of lawsuits may make physicians reluctant to disclose medical errors to patients

Ethicists and professional organizations recommend that doctors reveal medical errors to patients, but they are often reluctant to do so due to fear of a malpractice suit or damaged reputation. However, patients want to know about errors that affect them and would like an apology from their doctor. In turn, doctors are upset when errors happen but are unsure where to seek emotional support, according to a study supported by the Agency for Healthcare Research and Quality (HS11898). The researchers who conducted the study suggest that doctors apologize to patients, let them know about the nature and cause of the error, and explain how they plan to prevent similar errors in the future.

The researchers analyzed transcripts of discussions about medical error disclosure among 13 focus groups: six groups of adult patients, four groups of academic and community physicians, and three groups of both physicians and patients, with a total of 52 patients and 46 physicians involved. All groups were presented with a hypothetical error of a doctor's handwritten order being misinterpreted, resulting in the diabetic patient getting an overdose of insulin. After a period in the intensive care unit, the patient recovers uneventfully. Another scenario was discussed in which the nurse caught the error before administering the insulin.

Patients wanted doctors to disclose all harmful errors honestly and compassionately. They wanted to know what happened, why the error happened, how the error's consequences would be mitigated, and how recurrences would be prevented. Doctors agreed that harmful errors should be disclosed but said that they "choose their words carefully." Patients also wanted an apology. However, doctors worried than an apology might create legal liability. Patients had mixed feelings about disclosure of near misses, while most physicians considered that disclosing near misses was impractical and would diminish patient trust.

See "Patients' and physicians' attitudes regarding the disclosure of medical errors," by Thomas H. Gallagher, M.D., Amy D. Waterman, Ph.D., Alison G. Ebers, and others, in the February 26, 2003, Journal of the American Medical Association 289(8), pp. 1001-1007.

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