Medical errors: Disclosure and apology

Key Points

Since release of the Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System in 1999, increased attention has been focused on medical errors and adverse events because they occur frequently and often are not reported or discussed with affected patients and families.¹ Yet authorities consider it good medical practice to discuss these situations. In 2001, the Joint Commission released a standard requiring practitioners and/or facilities to clearly explain outcomes that were significantly different from what was anticipated.²

David Hilfiker presciently captured the situation in his 1985 memoir: "The medical profession seems to have no place for its mistakes. Indeed, one would almost think that mistakes are sins. And if the medical profession has no room for doctors' mistakes, neither does society... . We see the horror of our mistakes, yet we cannot deal with their enormous emotional impact. Perhaps the only way to face our guilt is through confession, restitution, and absolution."⁶

Given the expectations of perfection and the emotional impact of errors, it's easy to see how challenging it can be for physicians to discuss medical errors with their patients. Yet, as put forth by the Joint Commission standard, outcomes must be clearly explained to patients and their families. Providers may consider this prospect daunting, but these discussions increase ratings of quality by patients, improve rates of recovery, decrease the number of malpractice suits, and decrease the average settlement amount in litigation.^8,9

Because many physicians see disclosure as a difficult and threatening process, many do not openly acknowledge errors to their colleagues or to their patients.¹⁰ A study published in February 2012 noted that a vast majority of physicians agreed completely that patients should be fully informed about the risks and benefits of medical interventions. However, one-third of physicians did not completely agree about disclosing serious medical errors to patients, and 20% did not completely agree that physicians should always tell patients the truth. This study raises further questions and concerns that patients are not receiving complete, accurate information from their physicians.¹¹

Acknowledgment of medical errors has an important effect on the physician-patient relationship. Physicians may discuss the adverse event but avoid acknowledging an error or offering an apology because they worry that apologizing will create medical liability and the admission of fault.¹¹ But patients typically are seeking emotional support, including an apology, from their provider after an error occurs. Lack of disclosure creates a disconnect in the physician-patient relationship and unmet needs in the patient.

Disclosure and apology can help both patient and physician resolve the distress associated with an error. In fact, an important element of a patient's response to a medical error is interaction with the provider. When a medical error occurs, a physician should do the following, at a minimum¹¹:

1. Make an explicit statement that an error occurred;

2. Provide a basic description of what the error was, why it happened, and how recurrences will be prevented; and

3. Offer an apology.