Physicians Keep Mum When They Observe Errors

Medical errors may happen more frequently than patients realize because their physicians are staying tight-lipped when they see an error, according to an article in the New England Journal of Medicine.

However, physicians aren’t necessarily keeping mum to protect their colleagues—sometimes they just don’t know how to approach the subject despite the consensus that physicians have an ethical duty to communicate openly with patients harmed by medical errors.

“One particular challenge is that although the literature assumes the physician providing the disclosure also committed the error, health care today is delivered by complex groups of clinicians across multiple care settings,” the authors wrote. “…Thus, many decisions about discussing errors with patients involve situations in which other clinicians were primarily responsible for the error.”

The authors further pointed out that actually there is little guidance for physicians when it comes to disclosing others’ mistakes. As a result, patients are told little because the physicians themselves are uncertain about what to do.

“Even when the facts surrounding harmful errors seem clear, other challenges can make it difficult to know what to say to the patient,” the authors wrote. “Clinicians may have legitimate concerns about destroying patients' trust in the involved colleague, especially if there is an ongoing care relationship. There are also worries about triggering litigation.”

A group of experts in patient safety, medical malpractice insurance and litigation, error disclosure, patient—provider communication, professionalism, bioethics, and health policy came up with best practice to follow to help with the difficult task of communicating errors.

They noted that since many families will need financial help, clinicians have an obligation to be truthful so patients and families can access compensation. However, before even approaching the patient, clinicians need to obtain the facts, which means they need to “improve their ability to discuss quality issues with one another.”

But more important than colleagues discussing the issue together is the fact that institutions need to ensure that, regardless which clinicians were involved, disclosure conversations occur with the patients.

“When faced with a potential error involving another health care worker, our conceptions of professionalism should lead us to turn toward, rather than away from, involved colleagues,” the authors wrote. “Although making the effort to understand what happened and ensure appropriate communication with the patient may challenge traditional norms of collegial behavior and involve additional demands on clinicians' time, transparent disclosure of errors is a shared professional responsibility.”