Policy of routine error disclosure may minimize impact of medical errors

People who believe their doctor or hospital would inform them if a medical error occurred are "far more forgiving" than those who doubt their health care provider would disclose the error, reports a study in the November issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

For health care providers, "publicly and credibly adopting a policy of routine error disclosure" may be the best approach to minimizing the impact of medical errors, suggests the new research, led by Lorens A. Helmchen, Ph.D., of University of Illinois, Chicago.

Confidence in Disclosure Affects Likely Responses to Medical Errors
The researchers surveyed a representative sample of Illinois residents regarding medical errors. About 40 percent of participants either had personal experience with medical errors, or had a close friend or family member who had been affected by an error.

Based on a hypothetical scenario, just ten percent of survey respondents believed their physicians would be "very likely" to tell them if a medical error occurred. About one-fourth said they would file a medical malpractice lawsuit if they were told about a medical error.

Respondents who trusted their doctor or hospital to disclose medical errors were no more (or less) likely to say they would sue. This was so even in a scenario where the health care provider offered to correct the problem through free additional medical treatment, and possibly a financial settlement.

However, people who trusted their health care provider to inform them about the error were more forgiving. Of the respondents who were most confident that their doctor or hospital would disclose the error, more than 60 percent said they would still recommend the provider, despite the error.

In contrast, only 30 percent of those who were skeptical about disclosure would continue to recommend the doctor or hospital. "It appears that patients' responses to actual medical error disclosure vary by their perception of the providers' likelihood to disclose medical errors in principle, rather than the level of information revealed," Helmchen and coauthors write.

Disclosure of medical errors is strongly preferred by patients, and is "ethically imperative" for doctors and hospitals. Yet the most common policy is to "deny and defend" when errors occur.

"The disclosure of medical errors to patients remains rare because providers fear that it will trigger lawsuits and jeopardize their reputation," according to the authors. Their study is one of the first to examine how patients might respond to a policy of openly disclosing and offering to remediate medical errors.

The results suggest that what patients believe about how their doctor or hospital would respond to an error has a significant impact on their behavior. Patients who trust their providers to disclose errors may be no less likely to sue, but appear more likely to forgive. "With their trust in the good intentions, albeit perhaps not the skill, of the provider largely intact, patients are less inclined to sue and more inclined to continue recommending the hospital," Helmchen and coauthors write.

Conversely, patients who are most skeptical about disclosure may view their health care provider with "suspicion and frustration"—even if they are told an error has occurred. Adopting a clear policy on error disclosure up front may help health care providers to fulfill their obligation to tell patients about errors while minimizing the damage caused by disclosure, the researchers believe.