Clinical Crossroads
Clinician's Corner
August 12, 2009

A 62-Year-Old Woman With Skin Cancer Who Experienced Wrong-Site SurgeryReview of Medical Error

Author Affiliations

Author Affiliation: Dr Gallagher is Associate Professor, Departments of Medicine and Bioethics and Humanities, University of Washington, Seattle.

JAMA. 2009;302(6):669-677. doi:10.1001/jama.2009.1011

After a life-threatening complication of an injection for neck pain several years ago, Ms W experienced a wrong-site surgery to remove a squamous cell lesion from her nose, followed by pain, distress, and shaken trust in clinicians. Her experience highlights the challenges of communicating with patients after errors. Harmful medical errors occur relatively frequently. Gaps exist between patients' expectations for disclosure and apology and physicians' ability to deliver disclosures well. This discrepancy reflects clinicians' fear of litigation, concern that disclosure might harm patients, and lack of confidence in disclosure skills. Many institutions are developing disclosure programs, and some are reporting success in coupling disclosures with early offers of compensation to patients. However, much has yet to be learned about effective disclosure strategies. Important future developments include increased emphasis on institutions' responsibility for disclosure, involving trainees and other team members in disclosure, and strengthening the relationship between disclosure and quality improvement.