Doctors and errors: It's the culture

October 20, 2006

Perspective

What do doctors talk about when they discuss medical errors with patients?

That was the subject of two groundbreaking studies published in late summer in the Archives of Internal Medicine. Based on responses from more than 2,600 medical and surgical specialists in two US states (Missouri and Washington) and Canada, the studies shed light on several of doctors' core practices and assumptions.

In the first study, which employed a series of medical and surgical scenarios to assess how physicians disclose mistakes to patients, the majority of respondents (56 percent) said they'd mention the adverse event but not the error. Researchers found that the more apparent the error, the more likely doctors would be to fess up to it (51 vs 32 percent). While surgeons were more willing than medical specialists to disclose their slip ups, the nonsurgical respondents were approximately three times more likely to use the actual word "error" and nearly twice as likely to disclose specific details about what happened. Overall, Canadian physicians were somewhat more willing than their American counterparts to lay out specific details.

Indoctrination into this culture begins early. "All the emphasis in medical training is on not making any mistakes," says Lucian Leape, widely acknowledged as the father of this country's patient safety movement. Given this expectation of infallibility, Leape says, it's no wonder that doctors who slip up-and many do at one point or another-think of themselves as "bad" or somehow flawed. No wonder, too, that they're in no rush to talk about what they've done. "Trying to get doctors to overcome this kind of thinking has been the essence of the patient-safety movement for the last 10 years," says Leape, a former pediatric surgeon.

He hopes to drive home a countervailing message, which, in the nutshell, is this: You didn't make a mistake because you're a bad doctor or have some kind of character flaw. Good doctors, after all, are still forced to work in flawed systems. Still, you need to admit your mistake, talk about it, and help prevent it in the future. Communicating openly with patients, Leape adds, is "just one more aspect of this whole process."

Open communication with patients also makes pragmatic sense. "From our experience in several states, the US Department of Veterans Affairs, and other places," says Leape, "the evidence is now clear that open and full disclosure, followed by an apology, reduces rather than increases the risk of malpractice litigation."

Sometimes, it seems, the right thing to do is also the smart thing.