AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 2

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Case 2.2: Disclosure and Patient Information—Mr. Douglas's Angiogram Gets a Second Look

Related topic: Preventing errors

Because of their central role in the provision of medical care and the unique ethical obligations that flow from caring for vulnerable patients, physicians also have a responsibility to enhance patient safety through identification and correction of the causes of diagnostic or medical errors and patient harm. Uncovering the exact causes of an error—including systemic causes such as mislabeling of medications and failure to transmit information—and correcting them when possible should be high priorities. The error in the case at hand seems to be simply a mistake of human judgment, but, as Opinion 8.121 explains, an investigation should be undertaken nonetheless.

Opinion 8.121, "Ethical Responsibility to Study and Prevent Error and Harm"

In the context of health care, an error is an unintended act or omission, or a flawed system or plan, that harms or has the potential to harm a patient. Patient safety can be enhanced by studying the circumstances surrounding health care errors.

1) Because they are uniquely positioned to have a comprehensive view of the care patients receive, physicians must strive to ensure patient safety and should play a central role in identifying, reducing, and preventing health care errors. This responsibility exists even in the absence of a patient-physician relationship.
2) Physicians should participate in the development of reporting mechanisms that emphasize education and systems change, thereby providing a substantive opportunity for all members of the health care team to learn.

Physicians concerned with the rise in professional liability claims and awards may think that the reporting and disclosing of errors and harms will only add to their problems. But some data suggest that the major determinant of the initiation of professional liability claims may be faulty communication and patient dissatisfaction [1, 2], rather than the quality of care [3]. On the basis that transparency—as opposed to secrecy—promotes trust, commentators have argued that open disclosure of errors may mitigate patient discontent and maintain patient confidence and, therefore, may be an important tool to reduce the risk of professional liability [4]. Such advice appears consistent with a recent study, which found that 98 percent of individuals who were presented with various scenarios expected or wished for the physician's active acknowledgement of an error [5]. Some patients may file lawsuits specifically to uncover information they otherwise have not been able to obtain. Also, for many patients, an offer of money is less likely to make them terminate a legal action against a physician than an explanation, an apology, and an assurance that corrective measures would be undertaken to prevent future similar errors [6].


References

  1. Wu AW. Handling hospital errors: is disclosure the best defense? Ann Intern Med. 1999;131:970-972.
  2. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Arch Intern Med. 1994;154:1365-1370.
  3. Levinson W. Physician-patient communication: A key to malpractice prevention. JAMA.1994:272:1619-1620.
  4. Kraman SS, Hamm G. Risk management: Extreme honesty may be the best policy. Ann Intern Med. 1999;131:963-967.
  5. Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? Arch Intern Med. 1996;156:2565-2569.
  6. See Vincent, Charles and Magi Young. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994;343:1609.

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