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Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients' and Physicians' Attitudes Regarding the Disclosure of Medical Errors. JAMA. 2003;289(8):1001–1007. doi:10.1001/jama.289.8.1001
Author Affiliations: Departments of Medicine and Medical History and Ethics, University of Washington School of Medicine, Seattle (Dr Gallagher); Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Mo (Drs Gallagher, Waterman, and Fraser and Ms Ebers); and the Department of Medicine, University of Toronto, Toronto, Ontario (Dr Levinson).
Context Despite the best efforts of health care practitioners, medical errors
are inevitable. Disclosure of errors to patients is desired by patients and
recommended by ethicists and professional organizations, but little is known
about how patients and physicians think medical errors should be discussed.
Objective To determine patients' and physicians' attitudes about error disclosure.
Design, Setting, and Participants Thirteen focus groups were organized, including 6 groups of adult patients,
4 groups of academic and community physicians, and 3 groups of both physicians
and patients. A total of 52 patients and 46 physicians participated.
Main Outcome Measures Qualitative analysis of focus group transcripts to determine the attitudes
of patients and physicians about medical error disclosure; whether physicians
disclose the information patients desire; and patients' and physicians' emotional
needs when an error occurs and whether these needs are met.
Results Both patients and physicians had unmet needs following errors. Patients
wanted disclosure of all harmful errors and sought information about what
happened, why the error happened, how the error's consequences will be mitigated,
and how recurrences will be prevented. Physicians agreed that harmful errors
should be disclosed but "choose their words carefully" when telling patients
about errors. Although physicians disclosed the adverse event, they often
avoided stating that an error occurred, why the error happened, or how recurrences
would be prevented. Patients also desired emotional support from physicians
following errors, including an apology. However, physicians worried that an
apology might create legal liability. Physicians were also upset when errors
happen but were unsure where to seek emotional support.
Conclusions Physicians may not be providing the information or emotional support
that patients seek following harmful medical errors. Physicians should strive
to meet patients' desires for an apology and for information on the nature,
cause, and prevention of errors. Institutions should also address the emotional
needs of practitioners who are involved in medical errors.
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