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Physicians' Disclosures of Errors to their Patients Can Vary Widely

Physicians are more likely to disclose medical errors that would be most apparent to the patient, according to two studies that recently appeared in the Archives of Internal Medicine. The studies found that while physicians in the United States and Canada generally support disclosing medical errors to patients, they vary widely in when and how they would tell patients an error had occurred.

Less than half of harmful errors may be disclosed to patients, according to background information in the articles. In the first study, the researchers presented physicians with one of four scenarios involving a medical error. Two of the scenarios were tailored to internal medicine specialists and two to surgeons; one of each type of error would be apparent to the patient, and the others would not be apparent to the patient if he or she was not informed.

For instance, the more apparent surgical error involved a sponge left inside a patient's body and the less apparent surgical error involved an internal injury that a surgeon inflicted because of unfamiliarity with a new surgical tool. The physicians answered a series of questions about the scenario they received, including how likely they would be to disclose the error, what information they would convey if they did disclose the error, how serious the error was and how likely it was to result in a lawsuit.

The study found:

► 85% of the physicians agreed that the error they received was serious

► 81% believed the physician was primarily responsible

► of physicians presented with an obvious error, 81% indicated they would definitely disclose the error, but only 50% of physicans presented with a non-apparent error indicated that they would definitely disclose it to the patient

► another 29% of all respondents said they would probably disclose the error

► 4% would disclose only if the patient asked

► 1% would definitely not disclose.

The language the physicians would use also varied widely:

► 42% would use the word "error"

► 56% would mention the adverse event but not the error

► 50% would give the patient specific information

► 13% would not reveal any details not requested by the patient.

The first study also found that specialty and the nature of the error affected how likely the physicians were to disclose the error. Surgeons were more likely than other physicians to say they would definitely disclose the error (81% vs. 54%) but also reported that they would disclose less information — 35% of surgeons and 61% of other physicians said they would disclose specific details about the error.

In a second study based on the same survey, researchers found that U.S. and Canadian physicians have similar attitudes toward error disclosure despite different malpractice environments, suggesting that the probability of lawsuits does not affect their views on disclosure.

Of the 2,637 physicians surveyed:

► 64% agreed that errors were a serious problem

► 98% supported disclosing serious errors to patients and 78% supported disclosing minor errors

► 58% had disclosed an error to a patient and 85% of those were satisfied with the disclosure

► 66% agreed that disclosing a serious error reduces malpractice risk.

About these data: Thomas H. Gallagher, M.D., University of Washington School of Medicine, Seattle, and colleagues surveyed physicians in the United States and Canada. The 2,637 physicians averaged 49.2 years of age and had been in practice for an average of 16.8 years; 1,233 were from the United States (from Washington and Missouri) and 1,404 were from Canada; about half (49.7%) were medical specialists, 40.3% were surgeons, 8.5% were in family practice, and 1.4% did not list their specialty; and 78.6% were male and 18.6% female. Arch Intern Med. 2006;166:1605-1611.