Opinion: Practicing Full Disclosure medicine

February 1, 2009

Fear of litigation, damage to reputation, and ostracism by peers have been responsible for a "code of silence." The wiser course in most circumstances is to reveal one's mistakes, and have a well thought out protocol for providing full disclosure.

Disclosing medical errors represents another such dilemma for ob/gyn chairs because we must balance fiduciary duties to our organizations to protect them against lawsuits and financial loss, (i.e., promote sustainability) against our obligation to respect a patient's autonomy, protect her from harm, be truthful, and avoid conflicts of interest. This ethical conundrum falls under the rubric of duty-based ethics.1

Should we disclose medical errors?

Undeterred, the IOM issued a second equally provocative report advocating revolutionary changes in health-care organization to insure that care was safe, effective, patient centered, timely, efficient, and equitable.6 The IOM's guiding principle was that hospitals must become "learning organizations." It was clear to many that transparency and public reporting of errors would be crucial to implementing the far-reaching quality improvement practices advocated by the IOM. It was only a small step to conclude that such transparency should include full disclosure of medical errors.7

There are many imperatives for full disclosure, including a regulatory requirement. For example, the Joint Commission regulations require that patients be informed of unanticipated outcomes causing serious harm. There also are professional mandates to disclose medical errors from the AMA, AHA, and ANA. And of course, patients want and expect such disclosure. One survey of 149 outpatients revealed that 98% desired some acknowledgment of even minor errors and these patients were significantly more likely to consider litigation if their physician did not disclose the error.8 And finally, there are the ethical obligations for such disclosure.7 Unfortunately, less than half of medical errors are disclosed.8