What physicians don't disclose about adverse events

When it comes to disclosing errors to patients, there are a wide variety of tactics used by physicians. In a study published in the Archives of Internal Medicine (8/14-28/2006), researchers mailed a survey to 2,637 physicians in Missouri, Washington, and Canada. Physicians who completed the survey read one of four scenarios depicting serious medical or surgical errors and answered questions designed to measure how they would disclose the errors to patients.

The researchers found that 56% of respondents would disclose an adverse event but not an error but only 42% would admit that an adverse event was due to an error; 13% said they would not volunteer details unless asked by the patient. The vast majority of respondents would offer an apology, with 61% expressing regret ("I am sorry about what happened") and 33% giving an explicit apology ("I am sorry that you were harmed by this error"). Moreover, 54% would make a pledge to prevent recurrences, while only 37% would discuss detailed plans for preventing future errors; the remaining 9% would provide no information about error prevention unless asked.

The diverse approaches to disclosing medical errors to patients reflects the conflict physicians face to promote full disclosure while protecting themselves from legal liability. The researchers advise the medical profession to develop guidelines that outline the information that patients can expect from physicians when an error does occur. They wrote, "Ideally, if these guidelines can help physicians choose their words following errors in closer alignment with patients' preferences, including apologizing and providing information about preventing recurrences, such disclosure could enhance patients' confidence in the honesty and integrity of the health-care system."