Disclosing Medical Errors to Patients: Attitudes and Practices of Physicians and Trainees

Abstract BACKGROUND Disclosing errors to patients is an important part of patient care, but the prevalence of disclosure, and factors affecting it, are poorly understood. OBJECTIVE To survey physicians and trainees about their practices and attitudes regarding error disclosure to patients. DESIGN AND PARTICIPANTS Survey of faculty physicians, resident physicians, and medical students in Midwest, Mid-Atlantic, and Northeast regions of the United States. MEASUREMENTS Actual error disclosure; hypothetical error disclosure; attitudes toward disclosure; demographic factors. RESULTS Responses were received from 538 participants (response rate = 77%). Almost all faculty and residents responded that they would disclose a hypothetical error resulting in minor (97%) or major (93%) harm to a patient. However, only 41% of faculty and residents had disclosed an actual minor error (resulting in prolonged treatment or discomfort), and only 5% had disclosed an actual major error (resulting in disability or death). Moreover, 19% acknowledged not disclosing an actual minor error and 4% acknowledged not disclosing an actual major error. Experience with malpractice litigation was not associated with less actual or hypothetical error disclosure. Faculty were more likely than residents and students to disclose a hypothetical error and less concerned about possible negative consequences of disclosure. Several attitudes were associated with greater likelihood of hypothetical disclosure, including the belief that disclosure is right even if it comes at a significant personal cost. CONCLUSIONS There appears to be a gap between physicians’ attitudes and practices regarding error disclosure. Willingness to disclose errors was associated with higher training level and a variety of patient-centered attitudes, and it was not lessened by previous exposure to malpractice litigation. Lauris C. Kaldjian1, 2 , Elizabeth W. Jones1, 3, Barry J. Wu4, Valerie L. Forman-Hoffman1, 3, Benjamin H. Levi5 and Gary E. Rosenthal1, 3 (1) Division of General Internal Medicine, Department of Internal Medicine, 1-106 MEB, University of Iowa Carver College of Medicine, 500 Newton Road, Iowa City, IA 52242, USA (2) Program in Biomedical Ethics and Medical Humanities, University of Iowa Carver College of Medicine, Iowa City, IA, USA (3) Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, IA, USA (4) Department of Internal Medicine, Hospital of St. Raphael, New Haven, CT, and Yale University School of Medicine, New Haven, CT, USA (5) Departments of Humanities and Pediatrics, Penn State College of Medicine and Hershey Medical Center, Hershey, PA, USA