Refusal of Disclosure

Editorial New York Times, September 9th, 2006
When doctors hide medical errors.


It’s probably no surprise that doctors a less likely to admit a serious mistake if they think they can get away with it than if they think the patient will find out. But now we have confirmation from a survey of some 2,600 doctors in the United States and Canada concerning what they would tell patients about serious medical errors in four hypothetical cases.
The doctors talked a good game ” fully 98 percent endorsed the need to disclose serious errors to patients, according to survey results published in the Archives of Internal Medicine. But most had something less than full disclosure in mind. Only 42 percent would actually use the word ‘error’,” while 56 percent would mention the adverse event but not the error, relegating the harm to the ‘stuff happens’ category. Only 33 percent would explicitly apologize for their mistake.
If the error were apt to become obvious ” say a sponge left in the patient’s body that required a follow-up operation, or an insulin overdose that required resuscitation and transfer to intensive care ” the doctors were far more apt to admit error and apologize than if the error was too subtle for most patients to recognize. “Basing disclosure decisions on whether the patient was aware of the error is not ethically defensible or consistent with standards,” the authors admonish their colleagues.
The researchers are dubious that limits on malpractice suits would have much impact on what doctors admit. Changes in medical education to encourage disclosure of errors would surely help, as would computerized systems to detect errors that might otherwise remain unnoticed. As it is, doctors seem reluctant to provide what patients deserve and say they want: an explicit acknowledgment of error, information about why it happened, and an apology from their physician.

 

 

 
 

Comment:
fear of litigation is a strong impediment for physicians not to inform patients on the occurrence of medical errors. However, experience in a.o. the Veteran Affairs Hospitals and the University of Michigan Health System Hospital has shown that when honesty and openness are applied, patients are less likely to sue.
The Sorry Works Coalition (www.sorryworks.net) in the USA promotes
honesty by physicians and hospitals and the offering of apologies to victims/members of their family in case of a medical error. This approach will hopefully be adopted by all medical professionals and hospitals.