Survey: Doctors respond differently after error
A survey conducted by Thomas H. Gallagher, MD, assistant professor at the University of Washington School of Medicine in Seattle, included scenarios that presented medical errors to the physician and risk manager respondents and then asked them how they would disclose the error to patients. The responses revealed startling differences.
In one scenario, a nurse gives a patient 10 times the correct dose of insulin because she misread the physician's sloppily written order. The patient nearly dies but recovers. Both groups were asked if and how they would disclose the mistake. Both favored disclosure, with 11.1% of risk managers and 31.8% of physicians saying they would "probably disclose the error." Another 87.4% of risk managers and 64.8% of physicians said they "definitely would disclose the error."
But they did not agree on how they would disclose. Almost no one opted for the first choice: telling the patient his blood sugar went too low but giving no hint of the insulin overdose. The next option was, "Your blood sugar went too low because you received more insulin than you needed." This not-quite-full disclosure was chosen by 51.4% of risk managers but only 27.6% of physicians.
The third option was, "Your blood sugar went too low because an error happened and you received too much insulin." This wording was chosen by 48.2% of risk managers and 71.4% of physicians.
"So risk managers are evenly split on whether to say 'error' and interestingly, physicians are more in favor of this full disclosure of the error," Gallagher says.
In a follow-up question with the same scenario, physicians again were more willing to use the word "error" in their apologies than risk managers. Forty-three percent of physicians were willing to say, "I am so sorry that you were harmed by this error," compared to only 23% of risk managers. The less-specific apology, "I am sorry about what happened," was chosen by 76% of risk managers and 54% of physicians.
Avoiding the word 'error'
Other survey results, however, suggested that surgeons (as opposed to other physicians) will be less willing to use the word "error" when talking to the patient. Surgeons' responses on that issue were more in line with risk managers'.
Gallagher says the survey results, and the discussion by ASHRM attendees at the conference session, suggest that risk managers are sometimes more committed to disclosing "errors" in theory than in practice. When faced with a specific scenario, risk managers often favor stating the bare facts and letting the patient figure out that an error occurred, he says, a position advocated by many of the risk managers attending his presentation.
Gallagher says that reluctance to say the word "error" can backfire if the patient perceives the health professional as evasive or trying to minimize the mistake. "The question becomes what is the minimum information you need to disclose without the patient asking for it," he says. "There's no answer on that yet, but it is clear that dribs and drabs of information, forcing the patient to ask for more and more information, can contribute to the patient's anger."
A survey conducted by Thomas H. Gallagher, MD, included scenarios that presented medical errors to the physician and risk manager respondents and then asked them how they would disclose the error to patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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