Risk managers, doctors disagree on 'full disclosure'
Risk managers and physicians have both joined the movement toward full disclosure with gusto, but a recent survey suggests that it is easier to talk about your dedication to informing the patient than it is to actually do it. When it comes to the specifics of exactly what to tell the patient, risk mangers and physicians often disagree and — surprisingly — the physicians are often more in favor of telling the patient the whole story than the risk managers are.
The intriguing results were the result of a survey of 1,798 members of the American Society for Healthcare Risk Management (ASHRM) and 1,233 physicians. The survey results were presented at the recent annual ASHRM meeting by Thomas H. Gallagher, MD, assistant professor of medicine at the University of Washington School of Medicine in Seattle, along with Kerry M. Bommarito, MPH, and Alison G. Ebers, researchers at Washington University School of Medicine in St. Louis.
Gallagher says the results may come as a surprise to risk managers who have jumped on the "full disclosure" bandwagon and think that simply endorsing the concept will bring change to their operations. "We all agree to a great extent on the principles of disclosure, but there is a gap between the principles and what we actually do," he says.
Both groups harbor misgivings
Gallagher notes that it has taken years for risk managers and physicians to accept the idea of full disclosure instead of keeping patients in the dark about what happened to them, but he says the survey results suggest there still is much work to be done if the principles of full disclosure are to be put into practice on an everyday basis. Clearly, he says, physicians and risk managers still harbor some misgivings about telling patients the facts — all the facts, without waiting for the patient to ask — and in some scenarios, the risk managers are more wary than the physicians.
That wariness is counter to the notion, common in many discussions of full disclosure, that risk managers embrace the new approach to full disclosure but are stymied by physicians who fear they will encourage a lawsuit or damage their own reputations. "One explanation is that the health care professional in risk management knows disclosure is the right thing to do but lacks the moral courage to pull it off," Gallagher says. "I tend to favor some more complex explanations."
Plus, Gallagher says, it's not as if physicians are unanimous in their support of full disclosure or consistent in how they practice it. There is a growing concern among some physicians that there now is too much focus on the patient, he says, with no consideration of how disclosure can affect the health care provider.
The survey of ASHRM members and physicians revealed a significant "disclosure gap" in several areas, Gallagher says.
First, the survey results suggest that risk managers are more firmly convinced of the seriousness of medical errors, with 83% agreeing that medical errors are "one of the most serious problems in health care," compared to only 64% of physicians. Risk managers also are far more convinced that medical errors are "usually caused by failures of care delivery systems, not the failure of individuals," with 84% agreeing with that statement, compared to only 54% of physicians.
Physicians do acknowledge that being involved with an error can seriously affect their own lives. Sixty percent of the physicians say a medical error created anxiety about being involved in future errors. Forty-six percent say that being involved with a medical error has affected their confidence as a physician, 43% say it has affected their job satisfaction, 42% say it has interfered with their ability to sleep, and 13% think it has affected their professional reputation.
Despite that angst, physicians aren't all that eager to pursue counseling after a medical error. Twenty percent said they would not be interested at all in counseling after involvement in a serious error, and 52% said they would be somewhat interested. Only 28% said they would be very interested. The biggest barrier to seeking counseling was a concern that it would take time away from the doctor's work, cited by 47% of the respondents. Other common concerns included confidentiality, creating a record of the counseling, effects on malpractice insurance, and thinking that counseling just would not be helpful.
Bommarito reports that the survey revealed 71.8% of the risk managers officially have approved disclosure policies at their facilities. Error reporting systems may go unused, however. When asked if their facilities have an error reporting system to improve patient safety, 81% of risk managers but only 37% of physicians said yes.
"Forty-five percent of physicians said they didn't know if their hospital had an error reporting system," she notes. "That's a big problem."
The survey also revealed that risk managers have an inflated idea of how well their error reporting systems work. Fifty-seven percent of risk managers agreed with the statement that their current system for facilitating physician reports about patient safety are adequate, but only 30% of the physicians thought so. When asked about mechanisms for informing physicians about errors in their facilities, 51% of risk managers thought they worked well, but only 18% of physicians agreed.
Sources
For more information on disclosing errors, contact:
- Kerry M. Bommarito, Research Patient Coordinator, Department of Internal Medicine, Box 8051, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110. Telephone: (314) 362-5000. E-mail: [email protected].
- Thomas H. Gallagher, Assistant Professor, Department of Medicine, Box 356178, University of Washington School of Medicine, Seattle, WA 98195. Telephone: (206) 543-4802. E-mail: [email protected].
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