Our Chief Privacy Officer sent me an interesting article today about how hospitals are promoting “disclosure and apology” (by physicians to patients or their families) when a medical error is committed. The report suggests that less money will be spent in malpractice suits if physicians fess up to their mistakes instead of trying to hide them.
Another study suggests that 99% of physicians believe that it is morally right to confess errors to patients and family members, but that only about 33% report doing so. The article says that the number one reason why they don’t report errors is fear of being sued.
While these statistics don’t reflect well on physicians, I think there’s some murkiness here that’s worth reviewing. First of all, what constitutes an error? When a young resident physician performs a procedure in an inferior manner due to lack of experience, is that an error? When a code team is not called soon enough because a patient doesn’t appear gravely ill initially, is that an error? If an unconscious patient arrives in the ER and is treated with a medicine that causes a life-threatening allergic reaction, is that an error? I think that many times physicians perceive some “errors” as unfortunate and regrettable aspects of the natural practice of medicine and don’t report them formally.
Another reason why physicians may not report errors is because it’s unclear that the error has a specific adverse effect – perhaps a patient’s Tylenol was given at the wrong time of day. That’s an error – but is it worthy of formally reporting it to the patient? What about when the lab loses the tube of blood drawn from a patient? Should the patient be told about it or should the labs be added to the next day’s scheduled draw?
The majority of “errors” that I’ve witnessed are in the realm of sub-optimal care due to inexperience, inattentiveness, or misinterpretation of test results. However, errors of the sort that result in death and serious harm appear to be alarmingly frequent (some studies argue that there are 40-90 thousand of these errors per year).
I think that physicians should always tell patients the truth about their care, the risks associated with certain procedures, and the full range of choices that are available to them. I do believe that patients value (and deserve) to know the truth - even when it makes the physician or hospital seem less than perfect. In the cases of errors that result in serious consequences – honesty is the best (and only) policy.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.