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Semin Med Pract 
2004 ;7:24-33
Disclosing medical error: a professional standard
Lemon MR, Hobgood C, Hevia A

This article examines professional issues raised when a medical error occurs in the course of patient care. Using the scenario of a patient who presents to the emergency department with active chest pain, the reader is walked through the events that set the stage for a resident to inadvertently administer a high rate of intravenous nitroglycerin rather than a fluid bolus. Although no serious patient harm occurs, the resident must decide whether to disclose the mistake to the patient and the attending physician. Applying the professional responsibilities outlined by the Charter on Medical Professionalism, the authors examine important reasons why error disclosure is appropriate in this case. The article also illustrates an approach to disclosing errors to patients and highlights some of the barriers to error disclosure in medical educational settings.

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