Wednesday, January 12, 2011

Truth or consequences

While we are on the topic of medical errors, let's see how doctors feel about disclosing them when the patient has not been harmed. Medscape recently surveyed doctors on this question and published the results in a provocative article by Gail Garfinkel Weiss entitled: 'Some Worms Are Best Left in the Can' -- Should You Hide Medical Errors?" (A subscription is required, but it is free.)

To the doctors reading this, into which camp do you fall? To the patients reading this, what would you expect of your doctor in this kind of situation?

Some excerpts:

In response to the question "Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?" 60.1% of respondents answered "no," and the remaining respondents were almost evenly divided between "yes" (19%) and "it depends" (20.9%).

Professor Margaret R. Moon, MD, MPH, a pediatrician and faculty member at the Johns Hopkins Berman Institute of Bioethics at Johns Hopkins University, is squarely in the "no" camp. "Physicians have a duty to put the patient's well-being first -- specifically, before their own," she says. "If patients don't believe the physician will do that, the whole doctor-patient relationship falls apart. In some circumstances, a physician might believe that the disclosure of error might harm the patient more than benefit the patient. But because it's difficult to know ahead of time how much a reasonable patient would want to know, erring on the side of disclosure makes the most sense."

Among the comments on the "yes"' side:

  • If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes.
  • Why make a mountain out of a molehill if it will cause the patient more emotional upset than not saying anything?
  • I see no benefit in revealing mistakes of no consequence, like giving a patient Tylenol 650 mg instead of 325 mg.
  • Why shake the patient's trust in the doctor for something that is irrelevant?
A somewhat different question about medical errors -- "Are there times when it is acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?" -- drew an almost unanimous response. A whopping 94.9% answered in the negative, 1.6% said "yes," and 3.5% said "it depends."

Some "yes" respondents hedged their bets, with one saying, "I would contact an attorney first." Another, who had no such hesitation, said, "If the mistake has not progressed to harmfulness, then it's essentially a non-issue. Treatment correction takes place and you move on." Ditto for the respondent who endorsed nondisclosure "if the mistake appears in no way possibly significant now or in the future."


Anonymous said...

Just ran across this abstract from AHRQ on this subject regarding formal disclosure/ethics training (some day I'll learn to embed links):


jonmcrawford said...

That's ridiculous. Full disclosure is the only way to gain and maintain trust. If I found out that my physician made a mistake, and intentionally held it from me, regardless of severity, I'm leaving for another doc.

Engineer on Medicare said...

There is an interesting story in the NY Times about medical coverups in TX and the consequences of organized retribution against whistleblowers.

"A state grand jury in Winkler County, Tex., has indicted the sheriff, the county attorney and a hospital administrator for their roles in orchestrating the prosecution of two whistle-blowing nurses after they had reported allegations of malpractice."

Anonymous said...

OK, I am responding to Mary Ellen's challenge on your "hadn't reached a conclusion yet' post that I didn't answer the question. I am a doctor, though thankfully retired:

1. it depends.

2. no

nonlocal MD

Anonymous said...

I think it is much bigger problem and from what I have experienced, I can tell you that don't go by what the votes are saying coz people just like to believe that they do the right thing.

Some decission makers even proclaim that they are protecting the organization even when they create barriers and foster culture of not disclosing seriour adverse events....

If you have any solution, tips or advice on how to convery these top level nay sayers please post it ....


Molly said...

I think full disclosure should be given most of the times. Some people use Tylenol on a daily basis and they don't know the long term effects - tylenol liver damage. I found this interactive website on the history on pain relief. Might be useful for some.