 |
|
Choosing Your Words Carefully
How Physicians Would Disclose Harmful Medical Errors to Patients
Thomas H. Gallagher, MD;
Jane M. Garbutt, MB, ChB, FRCP;
Amy D. Waterman, PhD;
David R. Flum, MD, MPH;
Eric B. Larson, MD, MPH;
Brian M. Waterman, MPH;
W. Claiborne Dunagan, MD;
Victoria J. Fraser, MD;
Wendy Levinson, MD
Arch Intern Med. 2006;166:1585-1593.
Background A gap exists between patients' desire to be told about medical errors and present practice. Little is known about how physicians approach disclosure. The objective of the present study was to describe how physicians disclose errors to patients.
Methods Mailed survey of 2637 medical and surgical physicians in the United States (Missouri and Washington) and Canada (national sample). Participants received 1 of 4 scenarios depicting serious errors that varied by specialty (medical and surgical scenarios) and by how obvious the error would be to the patient if not disclosed (more apparent vs less apparent). Five questions measured what respondents would disclose using scripted statements.
Results Wide variation existed regarding what information respondents would disclose. Of the respondents, 56% chose statements that mentioned the adverse event but not the error, while 42% would explicitly state that an error occurred. Some physicians disclosed little information: 19% would not volunteer any information about the error's cause, and 63% would not provide specific information about preventing future errors. Disclosure was affected by the nature of the error and physician specialty. Of the respondents, 51% who received the more apparent errors explicitly mentioned the error, compared with 32% who received the less apparent errors (P<.001); 58% of medical specialists explicitly mentioned the error, compared with 19% of surgical specialists (P<.001). Respondents disclosed more information if they had positive disclosure attitudes, felt responsible for the error, had prior positive disclosure experiences, and were Canadian.
Conclusions Physicians vary widely in how they would disclose errors to patients. Disclosure standards and training are necessary to meet public expectations and promote professional responsibility following errors.
Author Affiliations: Departments of Medicine and Medical History and Ethics (Dr Gallagher) and Surgery and Health Services (Dr Flum), University of Washington School of Medicine, and Center for Health Studies, Group Health Cooperative (Dr Larson), Seattle, Wash; Department of Medicine, Washington University School of Medicine (Drs Garbutt, Waterman, Dunagan, and Fraser), BJC HealthCare (Dr Dunagan), and Waterman Research Solutions (Mr Waterman), St Louis, Mo; and Department of Medicine, University of Toronto, Toronto, Ontario (Dr Levinson).
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
US and Canadian Physicians' Attitudes and Experiences Regarding Disclosing Errors to Patients
Thomas H. Gallagher, Amy D. Waterman, Jane M. Garbutt, Julie M. Kapp, David K. Chan, W. Claiborne Dunagan, Victoria J. Fraser, and Wendy Levinson
Arch Intern Med. 2006;166(15):1605-1611.
ABSTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Commentary: Physician Apologies for Adverse Outcomes--Beware the Minefields of Mea Culpa
Legant
J Oncol Pract 2011;7:393-394.
FULL TEXT
Patients' and family members' views on how clinicians enact and how they should enact incident disclosure: the "100 patient stories" qualitative study
Iedema et al.
BMJ 2011;343:d4423-d4423.
ABSTRACT
| FULL TEXT
To lie or not to lie: resident physician attitudes about the use of deception in clinical practice
Everett et al.
J. Med. Ethics 2011;37:333-338.
ABSTRACT
| FULL TEXT
Communicating Pathology and Laboratory Errors: Anatomic Pathologists' and Laboratory Medical Directors' Attitudes and Experiences
Dintzis et al.
Am J Clin Pathol 2011;135:760-765.
ABSTRACT
| FULL TEXT
Responding to patient safety incidents: the "seven pillars"
McDonald et al.
BMJQS 2010;19:1-4.
ABSTRACT
| FULL TEXT
Interest-Based Mediation of Medical Malpractice Lawsuits: A Route to Improved Patient Safety?
Hyman et al.
Journal of Health Politics, Policy and Law 2010;35:797-828.
ABSTRACT
A new way of relating: perceptions associated with a team-based error disclosure simulation intervention
Jeffs et al.
BMJQS 2010;19:i57-i60.
ABSTRACT
| FULL TEXT
Disclosure of patient safety incidents: a comprehensive review
O'Connor et al.
Int J Qual Health Care 2010;22:371-379.
ABSTRACT
| FULL TEXT
Serious professional misconduct and the need for an apology
Whiting
Clin Ethics 2010;5:130-135.
ABSTRACT
| FULL TEXT
The Flaws In State 'Apology' And 'Disclosure' Laws Dilute Their Intended Impact On Malpractice Suits
Mastroianni et al.
Health Aff (Millwood) 2010;29:1611-1619.
ABSTRACT
| FULL TEXT
Disclosure of Hospital Adverse Events and Its Association With Patients' Ratings of the Quality of Care
Lopez et al.
Arch Intern Med 2009;169:1888-1894.
ABSTRACT
| FULL TEXT
Entering the Second Decade of the Patient Safety Movement: The Field Matures: Comment on "Disclosure of Hospital Adverse Events and Its Association With Patients' Ratings of the Quality of Care"
Wachter
Arch Intern Med 2009;169:1894-1896.
FULL TEXT
Disclosing Harmful Mammography Errors to Patients
Gallagher et al.
Radiology 2009;253:443-452.
ABSTRACT
| FULL TEXT
The Use of Apology in Health Care
Howley
Journal of Medical Marketing: Device, Diagnostic and Pharmacetical Marketing 2009;9:279-289.
ABSTRACT
Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases
Gallagher et al.
Chest 2009;136:897-903.
ABSTRACT
| FULL TEXT
A 62-Year-Old Woman With Skin Cancer Who Experienced Wrong-Site Surgery: Review of Medical Error
Gallagher
JAMA 2009;302:669-677.
ABSTRACT
| FULL TEXT
A New Structure of Attention?: Open Disclosure of Adverse Events to Patients and Their Families
Iedema et al.
Journal of Language and Social Psychology 2009;28:139-157.
ABSTRACT
Disclosing Harmful Pathology Errors to Patients
Dintzis and Gallagher
Am J Clin Pathol 2009;131:463-465.
FULL TEXT
Medical Error Disclosure Among Pediatricians: Choosing Carefully What We Might Say to Parents
Loren et al.
Arch Pediatr Adolesc Med 2008;162:922-927.
ABSTRACT
| FULL TEXT
Disclosing Medical Errors: We're Halfway There
Levinson
Arch Pediatr Adolesc Med 2008;162:991-992.
FULL TEXT
Lost Opportunities: How Physicians Communicate About Medical Errors
Garbutt et al.
Health Aff (Millwood) 2008;27:246-255.
ABSTRACT
| FULL TEXT
Disclosing medical errors to patients: a status report in 2007
Levinson and Gallagher
CMAJ 2007;177:265-267.
FULL TEXT
Confronting Medical Errors in Oncology and Disclosing Them to Cancer Patients
Surbone et al.
JCO 2007;25:1463-1467.
FULL TEXT
|
