Disclosure of Medical Errors: Attitudes of Iranian Internists and Surgeons
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 3 No. 1(Winter) (2013),
20 April 2013
,
Page 20-27
https://doi.org/10.22037/ijmtfm.v3i1(Winter).4007
Abstract
Background: Despite the widespread prevalence of medical errors and increased concerns of healthcare managers and the public about the disclosure of medical errors in recent decades, existing evidence shows that physicians still ignore the importance of disclosure of those errors. The present study aims to investigate the attitudes of Iranian internists and surgeons towards the disclosure of medical errors.
Method: In this cross-sectional study, after a research purpose briefing, a checklist eliciting basic information and a questionnaire measuring attitudes towards the disclosure of medical errors was distributed to participant physicians at Imam Khomeini Hospital, Tehran, Iran. The questionnaires were returned filled out by 107 participants (54 internists and 53 surgeons).
Results: Although 77%, 53% and 44% of the participants agreed to the disclosure of serious, minor and near miss medical errors, respectively, 83% believed that it's very difficult for them to disclose medical errors and 48% asserted that disclosure of medical errors would threaten patients' trust in physicians. In addition, 78% of the participants believed in notifying hospital or ward authorities of the occurrence of medical errors while only 53% agreed to notify colleagues in case of medical errors. Patients' litigations (51%), unfamiliarity with patients' temperament (46%) and patients' asperity (40%) were the most prevalence reasons for nondisclosure of medical errors. No significant difference was found among participants' attitudes in terms of sex and age groups (p>0.05). In terms of specialty, surgeons expressed significantly more agreement than internists about declaration of medical errors to hospital and ward authorities (87% Vs 70%, p=0.039) and to other colleagues (66% Vs 41%, p=0.009). In addition, the surgeons believed that the disclosure of medical errors would minimize the likelihood of patients' litigations (60% Vs 42%, p=0.049). Internists and surgeons' attitudes did not differ over other issues (p>0.05).
Conclusion: Although the majority of specialists agreed to the disclosure of serious medical errors, more than 80% of them regarded it as an awkward act. In addition, half of the participants considered disclosure as a threat to patient trust and felt deterred by patients' litigations. Therefore, it seems that disclosure of medical errors is a serious issue in Iran which needs to be addressed by healthcare system policy makers.
- Medical error disclosure
- Attitude
- Internist
- Surgeon
How to Cite
References
Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. U.S. Institute of Medicine. Committee on Quality of Health Care in America. Washington, DC: National Academy Pr; 2000.
Shojania KG, Duncan BW, McDonald KM et al. Safe but sound: patient safety meets evidence-based medicine. JAMA. 2002;288:508-13.
Leape LL, Berwick DM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002;288:501-7.
Volpp KG, Grande D. Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med. 2003;348:851-5.
Gallagher TH, Studdert D, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med. 2007;356: 2713-9.
Baker GR, Norton PG, Flintoft V et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170:1678-86.
Sorensen R, Iedema R, Piper D et al. Health care professionals’ views of implementing a policy of open disclosure of errors. J Health Serv Res Policy. 2008;13(4): 227–232.
American Medical Association Council on Ethical and Judicial Affairs. Code of Medical Ethics: Current Opinions. Chicago: American Med Assoc; 2000.
Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6.
Blendon RJ, DesRoches CM, Brodie M. Views of practicing physicians and the public on medical errors. N Engl J Med. 2002;347:1933-40.
Lamb RM, Studdert DM, Bohmer RM et al. Hospital disclosure practices: results of a national survey. Health Aff (Millwood). 2003;22:73-83.
Mazor KM, Simon SR, Yood RA. Health plan members’ views about disclosure of medical errors. Ann Intern Med. 2004;140(6): 409-18.
Thurman AE. Institutional responses to medical mistakes. Kennedy Inst Ethics J. 2001;11:147-156.
Cantor MD. Telling patients the truth. Qual Saf Health Care. 2002;11:7-8.
Wears RL, Wu AW. Dealing with failure. Ann Emerg Med. 2002;39:344-346.
Fraser VJ, Gallagher TH, Dunagan WC. Communicating About Medical Errors: Physicians' Attitudes and Experiences. Washington University in St. Louis. http://medicine.wustl.edu/~ptsafety/mdsurvey.htm.
Lo B. Resolving Ethical Dilemmas. 2nd ed. Philadelphia, Pa:Lippincott Williams & Wilkins. 2000.
May T, Aulisio MP. Medical malpractice, mistake prevention, and compensation. Kennedy Inst Ethics J. 2001;11:135-146.
Vincent CA, Coulter A. Patient safety: what about the patient? Qual Saf Health Care. 2002;11:76-80.
Gallagher TH, Garbutt JM, Waterman AD et al. Choosing your words carefully: how physicians would disclose harmful medical errors to patients. Arch Intern Med. 2006;166:1585-93.
Leape LL. Error in medicine. JAMA. 1994; 272:1851–7.
Vincent JL. Information in the ICU: are we being honest with our patients? The results of a European questionnaire. Intensive Care Med. 1998; 24:1251–6.
Sweet MP, Bernat JL. A study of the ethical duty of physicians to disclose errors. J Clin Ethics. 1997; 8:341–8.
Gallagher TH, Waterman AD, Ebers AG et al. Patients' and Physicians' Attitudes Regarding the Disclosure of Medical Errors. JAMA. 2003;289(8):1001-1007.
Department of Health (UK). An organization with a memory: report of an expert group on learning from adverse events in the NHS. http://www.dh.gov.uk/assetRoot/04/06/50/86/04065086.pdf. Accessed February 15,2006.
Pilpel D, Schor R, Benbassat J. Barriers to acceptance of medical error: the case for a teaching program. Med Educ. 1998;32(1):3–7.
Liang BA. A system of medical error disclosure. Qual Saf Health Care. 2002;11:64-68.
Downing L, Potter RL. Heartland Regional Medical Center makes a “fitting response” to medical mistakes. Bioethics Forum. 2001;17:12-18.
Flynn E, Jackson JA, Lindgren K et al. Shining the Light on Errors: How Open Should We Be? Oak Brook, Ill: University HealthSystem Consortium. 2002.
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