Survey: Physicians more likely to disclose obvious medical errors

Physicians in the United States and Canada are more likely to disclose obvious medical errors than less apparent ones, according to the results of a survey. Their decisions to disclose such errors, however, do not appear to be influenced by the malpractice environment, according to the researchers who conducted the survey.

Thomas H. Gallagher, MD, and colleagues at the University of Washington School of Medicine surveyed 2,673 physicians in the United States and Canada regarding their attitudes and inclinations for medical error disclosure. They also asked respondents to describe their malpractice environments. They analyzed the survey results in two studies published in the Archives of Internal Medicine.

The survey respondents included 1,233 U.S. physicians (from Washington and Missouri) and 1,404 Canadian physicians. Average age of the respondents was 49.2 years, and average time in practice was 16.8 years; 49.7% of respondents were medical specialists, 40.3% were surgeons, 8.5% were family practitioners and 1.4% did not indicate their specialty.

Despite differing malpractice environments, 98% of all respondents said they supported disclosing serious errors to their patients and 78% supported disclosing minor errors, according to a press release summarizing the study's findings. Additionally, 66% agreed that disclosing serious errors reduces the risk of a lawsuit, and 58% said they had previously disclosed an error to a patient. Of those who had previously disclosed an error, 85% said they were satisfied with the disclosure, the press release said.

In a second study based on the same survey data, the researchers presented physicians with one of four hypothetical scenarios involving a medical error to learn whether they would report that error, and if so, how it would be reported. Two of the hypothetical scenarios involved obvious medical errors, such as accidentally prescribing 10 times the proper dosage of insulin. The other two situations involved non-apparent errors, such as inflicting minor internal damage while using an unfamiliar surgical tool.

Of physicians presented with an obvious error, 81% indicated they would disclose the error. In contrast, only 50% of physicians presented with a non-apparent error indicated that they would disclose the error, according to the release.

Specialty and the nature of the error also affected the likelihood for physicians to disclose errors. Surgeons were more likely than other physicians — 81% vs. 54% — to indicate that they would definitely disclose an error. But surgeons also indicated they would disclose less information; 35% of surgeons and 61% of other physicians said they would disclose specific details about the error, according to the release.

"Some dimensions of errors might justify disclosing less information, such as if the error caused only trivial harm," the authors said in the study. "However, physicians agreed that all the scenarios represented serious errors. Basing disclosure decisions on whether the patient was aware of the error is not ethically defensible or consistent with standards such as those from the Joint Commission on Accreditation of Health Care Organizations."