Disclosure of “Nonharmful” Medical Errors and Other Events: Duty to Disclose | Health Care Safety | JAMA Surgery | JAMA Network
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    DISCLOSURE OF MEDICAL ERRORS; PERSPECTIVES FROM SUB-SAHARAN AFRICA
    Abdulrasheed Ibrahim, et al. | A.B.U.T.H Zaria Kaduna State Nigeria
    We read with great interest the article by Chamberlain et al 1 on Disclosure of "Nonharmful" Medical Errors and Other Events. Patient safety is a much bigger problem in developing countries, based on the number of preventable deaths from medical errors, compared with reports from developed economies.2 Surgery in sub-Saharan Africa is widely known to be done against a background of poverty and illiteracy, late presentation with complicated pathologies, and a desperate lack of infrastructure. Any of these factors can influence the pattern and disclosure of medical errors. However, just as public-health interventions and educational projects have greatly improved maternal and neonatal survival in sub- Saharan Africa, so might analogous efforts in disclosure of non harmful errors improve surgical outcome and quality of care. 3 Patient autonomy and self determination 1 are highly flavored by cultural practices and religious beliefs in Sub-Saharan Africa. The impact of these in the relationships between surgeons and patients, and between medical institutions and patients must be considered as it may affect disclosure and response to errors. We agree with the authors that disclosure should begin with the consent process, when the risks and benefits associated with a major procedure are discussed. 1 Indeed most surgeons have not received a formal training in disclosure. Overcoming this training deficit requires understanding how surgeons currently disclose errors and no studies have investigated how surgeons disclose both harmful and non harmful errors in sub-Saharan Africa. 4 The disclosure ball is in our court. References 1. Chamberlain CJ, Koniaris LG, Wu AW, Pawlik T M. Disclosure of "Nonharmful" Medical Errors and Other Events: Duty to Disclose. Arch Surg. 2012;147(3):282-286. 2. Wilson RM, Michel P, Olsen S, et al. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. BMJ. 2012;(344): e832 3. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. The Lancet. 2008;372(9633):139-144. 4. Chan DK, Gallagher TH, Reznick R, et al. How surgeons disclose medical errors to patients: A study using standardized patients. Surgery. 2005;138(5):851-858.
    CONFLICT OF INTEREST: None Reported
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    Special Article
    Mar 2012

    Disclosure of “Nonharmful” Medical Errors and Other Events: Duty to Disclose

    Author Affiliations

    Author Affiliations: Department of Surgery, School of Medicine (Ms Chamberlain and Drs Wu and Pawlik), and Department of Health Policy and Management, Bloomberg School of Public Health (Dr Wu), The Johns Hopkins University, Baltimore, Maryland; and Department of Surgery, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania (Dr Koniaris).

    Arch Surg. 2012;147(3):282-286. doi:10.1001/archsurg.2011.1005
    Abstract

    An estimated 98 000 patients die in the United States each year because of medical errors. One million or more total medical errors are estimated to occur annually, which is far greater than the actual number of reported “harmful” mistakes. Although it is generally agreed that harmful errors must be disclosed to patients, when the error is deemed to have not resulted in a harmful event, physicians are less inclined to disclose it. Little has been written about the handling of near misses or “nonharmful” errors, and the issues related to disclosure of such events have rarely been discussed in medicine, although they are routinely addressed within the aviation industry. Herein, we elucidate the arguments for reporting nonharmful medical errors to patients and to reporting systems. A definition of what constitutes harm is explored, as well as the ethical issues underpinning disclosure of nonharmful errors. In addition, systematic institutional implications of reporting nonharmful errors are highlighted. Full disclosure of nonharmful errors is advocated, and recommendations on how to discuss errors with patients are provided. An argument that full error disclosure may improve future patient care is also outlined.

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