Child/Adolescent Health

Some pediatricians would disclose errors only if harm is evident

Studies show that parents want to know when their children have been harmed by a medical error, and professional organizations, such as the Joint Commission, agree that clinicians should disclose medical errors. However, a new study finds that some pediatricians are inclined to be selective about which errors they report.

From July 1, 2003, to March 31, 2004, 205 pediatricians and pediatric residents responded to an 11-item survey on how they would respond after one of their patients was harmed by a medical error. Researchers from the University of Washington School of Medicine and Washington University School of Medicine posed two error scenarios: an insulin overdose that caused an intensive care unit stay and a failure to prescribe timely antibiotics that caused a hospitalization.

Nearly 80 percent of the pediatricians said the errors were serious, and 83 percent said they would feel responsible for the error. Further, 53 percent said they would definitely report the error, and 40 percent said they would probably report it. However, 7 percent said they would disclose the error only if the parent asked about it. Pediatricians with experience disclosing errors were more likely to explain how the error occurred. Yet training in error disclosure did not increase the likelihood that disclosure would occur.

Pediatricians who received the insulin overdose scenario were more likely to disclose the error and provide details about how it occurred than the pediatricians who received the antibiotic scenario. The authors suggest that this variation in disclosure practice, in addition to being at odds with disclosure guidelines and patient preferences, presents an opportunity for quality improvement work in error disclosure. Training should include opportunities to observe physicians disclosing errors and practice and feedback in error disclosure. This study was funded in part by the Agency for Healthcare Research and Quality (HS11898 and HS14012).

See "Medical error disclosure among pediatricians: Choosing carefully what we might say to patients," by David J. Loren, M.D., Eileen J. Klein, M.D., M.P.H., Jane Garbutt, M.B., Ch.B., and others in the October 2008 Archives of Pediatric and Adolescent Medicine 162(10), pp. 922-927.

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