Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Mistakes Happen: Best Practices for Disclosing Medical Errors to Patients
Description
The session titled "Mistakes Happen: Best Practices for Disclosing Medical Errors to Patients" covers the challenges and best practices related to disclosing medical errors. Led by Ariel Niggler, a dermatologist, and Samantha Goohan, a resident, it emphasizes the importance of open communication and disclosure following medical errors. The presenters outline the types of medical errors, including serious, minor, and near misses, and highlight the necessity of preventing further harm and documenting incidents. They stress that disclosure includes taking responsibility and can help reduce litigation risks, as patients often prefer an honest explanation over secrecy. The discussion also touches on the emotional impact of errors on healthcare providers, referred to as the 'second victim' phenomenon, and highlights the need for institutional support for physicians after such incidents. Legal aspects, including state-specific 'I'm sorry' laws, are discussed to guide practitioners on safe disclosure. The session ends with a practical role-playing exercise to practice effective communication with patients after an error, reinforcing that disclosing errors compassionately benefits both patients and healthcare professionals.
View moreConclusions
- Medical errors are common, with over a million occurring annually in the US, making it the third leading cause of death.
- Most medical errors are preventable, and understanding their types helps improve patient safety.
- Disclosures of medical errors can improve physician-patient trust and reduce litigation risk.
- Patient preferences strongly favor transparency about medical errors, as 98% want acknowledgment of errors regardless of severity.
- Full disclosures include admitting to the error and explaining its consequences, which are essential to patient care.
- There are ethical obligations for physicians to disclose errors guided by the AMA Code of Ethics and principles like beneficence and autonomy.
- Barriers to error disclosure include fear of litigation, insufficient knowledge, and institutional culture that discourages open communication.
- Programs to disclose errors, such as those seen at the University of Michigan, can reduce the rate of malpractice lawsuits and associated costs.
- Apology laws vary by state and can either protect or not protect physicians' statements of regret, influencing disclosure practices.
- Training and structured programs can enhance physicians' confidence in discussing medical errors with patients.
- Sameera V, Bindra A, Rath GP. Human errors and their prevention in healthcare. J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):328-335
- Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 May 3;353:i2139. doi: 10.1136/bmj.i2139
- Watson AJ, Redbord K, Taylor JS, Shippy A, Kostecki J, Swerlick R. Medical error in dermatology practice: development of a classification system to drive priority setting in patient safety efforts. J Am Acad Dermatol. 2013 May;68(5):729-37
- Kornmehl H, Singh S, Adler BL, Wolf AE, Bochner DA, Armstrong AW. Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015. JAMA Dermatol. 2018 Feb 1;154(2):160-166. doi: 10.1001/jamadermatol.2017.3713. PMID: 29214284; PMCID: PMC5839273
- Welsh D, Zephyr D, Pfeifle AL, Carr DE, Fink JL 3rd, Jones M. Development of the barriers to error disclosure assessment tool. J Patient Safe. 2017.
- Gallagher TH, Garbutt JM, Waterman AD, Flum DR, Larson EB, Waterman BM, Dunagan WC, Fraser VJ, Levinson W. Choosing your words carefully: how physicians would disclose harmful medical errors to patients. Arch Intern Med. 2006 Aug 14-28;166(15):1585-93.
- Varjavand N, Bachegowda LS, Gracely E, Novack DH. Changes in intern attitudes toward medical error and disclosure. Med Educ. 2012 Jul;46(7):668-77.
- Hobgood C, Peck CR, Gilbert B, Chappell K, Zou B. Medical errors-what and when: what do patients want to know? Acad Emerg Med Off J Soc Acad Emerg Med. 2002;9(11):1156-61
- Scott SD, Hirschinger LE, Cox KR, McCoig M, Hahn-Cover K, Epperly K, Phillips E, Hall LW. Caring for our Own: Deployment of a Second Victim Rapid Response System. The Joint Commission Journal on Quality and Patient Safety. 2010;36(5):233-240.
- Roberston et al. J Emergency Med 2018
- Ho B, Liu E: What's an apology worth? Decomposing the effect of apologies on medical malpractice payments using state apology laws. J Empirical Legal Stud 8:179-99, 2011
- Ho B, Liu E: Does sorry work? The impact of apology laws on medical malpractice. J Risk Uncertain 43:141-67, 2011
- McMichael BJ, Van Horn RL, Viscusi WK: Sorry is never enough: how state apology laws fail to reduce medical malpractice liability risk. Stan L Rev 71:341-409, 2019
- Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996 Dec 9-23;156(22):2565-9. PMID: 8951299.
- Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet. 1994;343:1609-1613.