J Clin Outcomes Manage
Should we disclose harmful medical errors to patients? If so, How?
Gallagher TH, Lucas MH
Abstract Objective: To assess the strength of the evidence for disclosing errors to patients, focusing on patients’ and physicians’ attitudes toward disclosure and disclosure’s effect on malpractice claims, and to present practical suggestions for disclosing medical errors. Methods: Review of the literature. Results: A gap exists between patients’ preferences for disclosure and current clinical practice. Patients have consistently expressed a desire to be told about harmful medical errors, and want to know why the error happened, how recurrences will be prevented, and to receive an apology. However, current data suggests that as few as 30% of harmful errors are disclosed to patients. Physicians support the general principle of disclosure, but hesitate to share the information patients want about errors. Physicians identify fear of liability as one important barrier to error disclosure and experience significant emotional distress after a harmful medical error. Limited data suggests that some institutions have adopted policies of more open disclosure without adverse malpractice consequences. The current disclosure literature contains important but unanswered questions, such as how patients’ preferences for disclosure vary along cultural and other dimensions, and whether recommended disclosure strategies improve patient trust and the likelihood of lawsuits. In the absence of definitive evidence about the outcomes of disclosure, practical suggestions for talking with patients about errors can be derived from the literature on doctor-patient communication, breaking bad news, and conflict resolution. Conclusion: Patients want to be told about harmful errors in their care, but at present such disclosure is uncommon. Closing gaps in the existing disclosure literature could help clinicians communicate more effectively with patients following harmful medical errors.
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