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Attitudes on Disclosure of Medical Errors

Patients and physicians have very different opinions about when and how errors should be disclosed.

Medical errors and initiatives to prevent them have been discussed widely in recent years. Physicians and patients generally agree that errors should be disclosed to patients, but do they agree on the details of such disclosure?

To address this question, researchers in St. Louis conducted 13 focus groups that involved 52 practicing physicians and 46 patients. Some groups included only physicians or only patients; others included both physicians and patients. The following points emerged:

• Patients defined errors broadly and included both preventable and nonpreventable adverse events; physicians defined errors as deviations from accepted standards.
  
• Patients wanted disclosure of all harmful errors; physicians agreed generally, but cited exceptions (e.g., errors causing only minimal harm, patients who "would not want to know").
  
• Patients had mixed opinions about disclosing "near misses;" most physicians opposed such disclosures.
  
• Patients wanted physicians to "tell everything" and wanted apologies; many physicians suggested that words should be chosen carefully and were concerned that apologies would create legal liability.
  
• Patients expressed various emotions, including anger and fear; physicians expressed mainly anxiety and guilt.
  

Comment: Not surprisingly, these findings demonstrate some gaps between the attitudes of patients and physicians. In part, physician reluctance to report errors is an understandable human reaction: Many people find it difficult to admit to making mistakes. But I also wonder whether physicians are getting conflicting messages: Although the ethics literature tends to urge unqualified full disclosure, physicians obviously remain concerned about their choice of words and the legal ramifications of apologies. Interested readers will want to look at the original article, which includes numerous quotes from participants in the study.

— Allan S. Brett, MD

Published in Journal Watch General Medicine March 11, 2003

Citation(s):

Gallagher TH et al. Patients' and physicians' attitudes regarding the disclosure of medical errors. JAMA 2003 Feb 26; 289:1001-7.

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• Medline abstract (Free)