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Medical Errors: Should Doctors Always Fess Up?

From the Medscape Medical Ethics article entitled “‘Some Worms Are Best Left In The Can’: Should You Hide Medical Errors?“:

Consequences aside, from a strictly ethical perspective, if a patient doesn’t realize that his physician made a mistake, should the physician fess up?

Before you jump to conclusions (as I did), look at the article’s three parts. It’s about a survey. The title is on the inflammatory side; the article is a window into physicians’ views. The introduction continues:

Evidence of the complex prisms through which physicians view these issues was apparent in the replies to four questions asked in Medscape’s exclusive ethics survey. More than 10,000 physicians responded to the survey in 2010.

Subheads:

– Mistakes that don’t harm patients. “Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” Sixty percent said “no;” the others split between “yes” and “it depends.”

  • I personally can understand this note from a survey respondent: “If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes,” especially since I know people (some elders, some young) who would indeed freak out, out of proportion. But, that’s a big judgment call.
  • I have a harder time accepting this comment: “Why shake the patient’s trust in the doctor for something that is irrelevant?” Irrelevant is a big judgment call, and I’d be really concerned about the natural human tendency to minimize the probable impact of a mistake — especially if a provider thinks it’s all about maintaining a patient’s trust, even when the topic is their own error.

– Mistakes that might harm patients. Ninety five percent said “no;” some still said “yes!” One commented: “If the mistake has not progressed to harmfulness, then it’s essentially a non-issue. Treatment correction takes place and you move on.” Another says if there hasn’t been harm yet, “I think a ‘wait and see’ approach is okay.”

– Is it self-serving to let sleeping dogs lie? Ethicist and pediatrician Professor Margaret R. Moon, M.D., M.P.H., agrees that when a mistake has the potential to cause harm, disclosure is the way to go. A “let sleeping dogs lie” strategy, or the aforementioned “wait and see” approach, may be in the physician’s best interests, she says, but it’s rarely in the patient’s best interests — especially if it was a clinical error, because clinical errors affect the patient’s body.

There will naturally be some selection bias — the above gives us no insight into the views of physicians who wouldn’t touch such a survey. But what do you think?

(Note: The survey included a final section on patient privacy, e.g. casual hallway conversations, but that’s outside the scope of this post.)

*This blog post was originally published at e-Patients.net*


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