Communicating With Patients About Medical Errors: A Review of the Literature | Health Care Safety | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
American Medical Association Council on Ethical and Judicial Affairs, Code of Medical Ethics: Current Opinions.  Chicago, Ill American Medical Association2000;
American College of Physicians, Ethics manual: fourth edition.  Ann Intern Med. 1998;128576- 594PubMedGoogle ScholarCrossref
Medical Professionalism Project, Medical professionalism in the new millennium: a physician charter.  Ann Intern Med. 2002;136243- 246PubMedGoogle ScholarCrossref
Joint Commission on Accreditation of Healthcare Organizations, 2004 Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH).  Oakbrook Terrace, Ill Joint Commission on Accreditation of Healthcare Organizations2004;
National Patient Safety Foundation, Talking to patients about health care injury: statement of principle. Available at: Accessed December 30, 2002.
Baylis  F Errors in medicine: nurturing truthfulness.  J Clin Ethics. 1997;8336- 340PubMedGoogle Scholar
Finkelstein  DWu  AWHoltzman  NASmith  MK When a physician harms a patient by a medical error: ethical, legal, and risk-management considerations.  J Clin Ethics. 1997;8330- 335PubMedGoogle Scholar
Hebert  PC Disclosure of adverse events and errors in healthcare: an ethical perspective.  Drug Saf. 2001;241095- 1104PubMedGoogle ScholarCrossref
Hebert  PCLevin  AVRobertson  G Bioethics for clinicians: 23: disclosure of medical error.  CMAJ. 2001;164509- 513PubMedGoogle Scholar
Kapp  MB Legal anxieties and medical mistakes: barriers and pretexts.  J Gen Intern Med. 1997;12787- 788PubMedGoogle ScholarCrossref
Kapp  MB Medical mistakes and older patients: admitting errors and improving care.  J Am Geriatr Soc. 2001;491361- 1365PubMedGoogle ScholarCrossref
Liang  BA A system of medical error disclosure.  Qual Saf Health Care. 2002;1164- 68PubMedGoogle ScholarCrossref
May  TAulisio  MP Medical malpractice, mistake prevention, and compensation.  Kennedy Inst Ethics J. 2001;11135- 146PubMedGoogle ScholarCrossref
Peterson  LMBrennan  T Medical ethics and medical injuries: taking our duties seriously.  J Clin Ethics. 1990;1207- 211PubMedGoogle Scholar
Porto  GG Disclosure of medical errors: facts and fallacies.  J Healthc Risk Manag. 2001;2167- 76PubMedGoogle Scholar
Rosner  FBerger  JTKark  PPotash  JBennett  AJCommittee on Bioethical Issues of the Medical Society of the State of New York, Disclosure and prevention of medical errors.  Arch Intern Med. 2000;1602089- 2092PubMedGoogle ScholarCrossref
Smith  MLForster  HP Morally managing medical mistakes.  Camb Q Healthc Ethics. 2000;938- 53PubMedGoogle ScholarCrossref
Thurman  AE Institutional responses to medical mistakes: ethical and legal perspectives.  Kennedy Inst Ethics J. 2001;11147- 156PubMedGoogle ScholarCrossref
Wu  AWCavanaugh  TAMcPhee  SJLo  BMicco  GP To tell the truth: ethical and practical issues in disclosing medical mistakes to patients.  J Gen Intern Med. 1997;12770- 775PubMedGoogle ScholarCrossref
Kohn  LTCorrigan  JMDonaldson  M , edsTo Err Is Human: Building a Safer Health System.  Washington, DC National Academy Press2000;
Campbell  DTStanley  JC Experimental and Quasi-experimental Designs for Research.  Chicago, Ill Rand McNally College Publishing Co1966;
Allman  J Bearing the burden or baring the soul: physicians' self-disclosure and boundary management regarding medical mistakes.  Health Commun. 1998;10175- 197Google ScholarCrossref
Gallagher  THWaterman  ADEbers  AGFraser  VJLevinson  W Patients' and physicians' attitudes regarding the disclosure of medical errors.  JAMA. 2003;2891001- 1007PubMedGoogle ScholarCrossref
Hobgood  CPeck  CRGilbert  BChappell  KZou  B Medical errors: what and when: what do patients want to know?  Acad Emerg Med. 2002;91156- 1161PubMedGoogle Scholar
Kraman  SSHamm  G Risk management: extreme honesty may be the best policy.  Ann Intern Med. 1999;131963- 967PubMedGoogle ScholarCrossref
Sweet  MPBernat  JL A study of the ethical duty of physicians to disclose errors.  J Clin Ethics. 1997;8341- 348PubMedGoogle Scholar
Vincent  CAPincus  TScurr  JH Patients' experience of surgical accidents.  Qual Health Care. 1993;277- 82PubMedGoogle ScholarCrossref
Vincent  JL Information in the ICU: are we being honest with our patients?the results of a European questionnaire.  Intensive Care Med. 1998;241251- 1256PubMedGoogle ScholarCrossref
Witman  ABPark  DMHardin  SB How do patients want physicians to handle mistakes? a survey of internal medicine patients in an academic setting.  Arch Intern Med. 1996;1562565- 2569PubMedGoogle ScholarCrossref
Wu  AWFolkman  SMcPhee  SJLo  B Do house officers learn from their mistakes?  JAMA. 1991;2652089- 2094PubMedGoogle ScholarCrossref
Beckman  HBMarkakis  KMSuchman  ALFrankel  RM The doctor-patient relationship and malpractice: lessons from plaintiff depositions.  Arch Intern Med. 1994;1541365- 1370PubMedGoogle ScholarCrossref
Blendon  RDesRoches  CMBrodie  M  et al.  Views of practicing physicians and the public on medical errors.  N Engl J Med. 2002;3471933- 1940PubMedGoogle ScholarCrossref
Hickson  GBClayton  EWGithens  PBSloan  FA Factors that prompted families to file medical malpractice claims following perinatal injuries.  JAMA. 1992;2671359- 1363PubMedGoogle ScholarCrossref
Hingorani  MWong  TVafidis  G Patients' and doctors' attitudes to amount of information given after unintended injury during treatment: cross sectional, questionnaire survey.  BMJ. 1999;318640- 641PubMedGoogle ScholarCrossref
Lamb  RMStuddert  DMBohmer  RMJBerwick  DMBrennan  TA Hospital disclosure practices: results of a national survey.  Health Aff (Millwood). 2003;2273- 83PubMedGoogle ScholarCrossref
Mizrahi  T Managing medical mistakes: ideology, insularity and accountability among internists-in-training.  Soc Sci Med. 1984;19135- 146PubMedGoogle ScholarCrossref
Novack  DHDetering  BJArnold  RForrow  LLadinsky  MPezzullo  JC Physicians' attitudes toward using deception to resolve difficult ethical problems.  JAMA. 1989;2612980- 2985PubMedGoogle ScholarCrossref
Vincent  CYoung  MPhillips  A Why do people sue doctors? a study of patients and relatives taking legal action.  Lancet. 1994;3431609- 1613PubMedGoogle ScholarCrossref
Huycke  LIHuycke  MM Characteristics of potential plaintiffs in malpractice litigation.  Ann Intern Med. 1994;120792- 798PubMedGoogle ScholarCrossref
Penchansky  RMacnee  C Initiation of medical malpractice suits: a conceptualization and test.  Med Care. 1994;32813- 831PubMedGoogle ScholarCrossref
May  MLStengel  DB Who sues their doctors? how patients handle medical grievances.  Law Soc Rev. 1990;24105- 120Google ScholarCrossref
Hickson  GBClayton  EWEntman  SS  et al.  Obstetricians' prior malpractice experience and patients' satisfaction with care.  JAMA. 1994;2721583- 1587PubMedGoogle ScholarCrossref
Levinson  WRoter  DLMullooly  JP  et al.  Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons.  JAMA. 1997;277553- 559PubMedGoogle ScholarCrossref
Wears  RLWu  AW Dealing with failure: the aftermath of errors and adverse events.  Ann Emerg Med. 2002;39344- 346PubMedGoogle ScholarCrossref
Vincent  CTaylor-Adams  SStanhope  N Framework for analysing risk and safety in clinical medicine.  BMJ. 1998;3161154- 1157PubMedGoogle ScholarCrossref
Helmreich  RLMerritte  AC Culture at Work in Aviation and Medicine: National, Organizational, and Professional Influences.  Brookfield, Vt Ashgate2001;
Hayward  RAHofer  RA Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer.  JAMA. 2001;286415- 420PubMedGoogle ScholarCrossref
Thomas  EJStuddert  DMBrennan  TA The reliability of medical record review for estimating adverse event rates.  Ann Intern Med. 2002;136812- 816PubMedGoogle ScholarCrossref
Original Investigation
August 9/23, 2004

Communicating With Patients About Medical Errors: A Review of the Literature

Author Affiliations

From the Meyers Primary Care Institute, University of Massachusetts Medical School, and Fallon Foundation, Worcester (Drs Mazor and Gurwitz); and Department of Ambulatory Care and Prevention, Harvard Medical School, and Harvard Pilgrim Health Care, Boston, Mass (Dr Simon). The authors have no relevant financial interest in this article.

Arch Intern Med. 2004;164(15):1690-1697. doi:10.1001/archinte.164.15.1690

Background  Ethical and professional guidelines recommend disclosure of medical errors to patients. The objective of this study was to review the empirical literature on disclosure of medical errors with respect to (1) the decision to disclose, (2) the process of informing the patient and family, and (3) the consequences of disclosure or nondisclosure.

Methods  We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and Social Sciences Citations Index) and the reference lists of relevant articles for English-language studies on disclosure of medical errors. From more than 800 titles reviewed, we identified 17 articles reporting original empirical data on disclosure of medical errors to patients and families. We examined methods and results of the articles and extracted study designs, data collection procedures, populations sampled, response rates, and definitions of error.

Results  Available research findings suggest that patients and the public support disclosure. Physicians also indicate support for disclosure, but often do not disclose. We found insufficient empirical evidence to support conclusions about the disclosure process or its consequences.

Conclusions  Empirical research on disclosure of medical errors to patients and families has been limited, and studies have focused primarily on the decision stage of disclosure. Fewer have considered the disclosure process, the consequences of disclosure, or the relationship between the two. Additional research is needed to understand how disclosure decisions are made, to provide guidance to physicians on the process, and to help all involved anticipate the consequences of disclosure.