Primary care physicians are willing to report medical errors within the healthcare organization, but are not as likely to tell the patients, according to a recent study from the School of Public Health at Georgia State University in Atlanta.
Kathleen Mazor, MD, a researcher at the Meyers Primary Care Institute in Worcester, MA, and her colleagues studied 397 primary care physicians, presenting them with two hypothetical cases involving a diagnosis of cancer. The researchers explained in the report, published recently in BMJ Quality and Safety, that the research was prompted by the trend in recent years to promote full disclosure of errors to patients with a statement of regret. Most healthcare professionals express support for the idea, but the researchers suspected they might not practice what they preach.
In the first scenario, the physicians recognized that breast cancer should have been diagnosed earlier than it was. In the second, a cancer patient suffered because care coordination delayed the response to the patient’s symptoms. The physicians were asked to imagine that they were the physician responsible for that patient.
After studying the information, the researchers asked the physician four questions about how they would respond after realizing an error had been made with their patient. The questions sought to determine if the doctor would apologize to the patient, offer an explanation of what error occurred, provide information about what factors led to the event, and/or discuss any plans for preventing a recurrence of the error. In each option, the physician could choose nondisclosure, partial disclosure, or full disclosure.
In addition, the physician responses were assessed for factors that could affect their disclosure decisions, including the level of personal responsibility for the error, beliefs about the seriousness of the event, time constraints, and expectations about whether a malpractice lawsuit was likely. The researchers also assessed factors such as how much the physician valued patient-centered communication and how much confidence the physician had in his or her ability to communicate. The study also factored in the physician’s perceived organizational-level support for open communication with patients.
The results confirmed suspicions that physicians do not disclose errors as fully as the healthcare community expects. A majority said they would not fully disclose the error in either scenario, though some would provide limited information without an apology. Seventy-seven percent said that in the delayed diagnosis case they would offer no information at all or only make a vague reference to miscommunication. In the failure to respond to symptoms scenario, that number was 58%.
With both scenarios, more than half of the physicians said they would not apologize at all or only make a vague statement about regret.
An abstract of the study is available online at http://bit.ly/2g7lQ1s.
