Patient attitudes about physician mistakes - Tips from Other Journals

Author: Barbara Apgar
Date: May 1, 1997

Physician mistakes occur even among conscientious professionals with high standards. Disclosure of mistakes to patients is a difficult process. Fear of litigation may force physicians to distance themselves from errors by denial, placing blame on others or not being available for patient concerns. Witman and associates examined patient attitudes about physician errors.

One hundred forty-nine patients from an academic general internal medicine outpatient clinic were randomly selected for a survey. The survey included case scenarios of physician errors and assessed patient attitudes regarding three levels of physician mistakes (minor, moderate and severe) and physician responses of disclosure and nondisclosure.

Nearly all (98 percent) of the respondents indicated that they desired or expected the physician's active acknowledgment of an error. As the error increased in severity, the desired response also increased in a similar manner. The proportion of patients who reported that they would desire referral to another physician ranged from 14 percent following a minor mistake to 65 percent following a severe mistake.

Many of the patients reported that they would like to speak further to the physician when a mistake was minor. In contrast, only one half of the patients would want to speak to the physician when the mistake was severe. Only 3 percent of patients would want to speak to the nurse, regardless of the severity of the error. The percentage of patients who would report the physician or file a lawsuit increased as the severity of the mistake increased.

Patients were significantly more likely to either report the physician or file a lawsuit when the mistake was not acknowledged by the physician. The risk of litigation nearly doubled in the moderate mistake scenario when the patient was not informed. The number of patients who would not return to the physician increased significantly when the physician did not disclose the error.

This study demonstrated that patients want full disclosure if a mistake occurs and want the physician to acknowledge the error in some way. This suggests that patients value being kept informed, even if the error is perceived as minor, and that physicians may be at increased risk for legal or professional sanctions by failing to disclose even minor errors.

The authors conclude that it is important for physicians to acknowledge mistakes and continue to act as the patient's advocate while recognizing that the mistake did occur. The combination of honestly disclosing the mistake and taking a more vigorous role in reducing future mistakes will result in less harm to patients and a reduced likelihood of litigation.

BARBARA APGAR, M.D., M.S. Witman AB, et al. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med 1996;156.2565-9.

COPYRIGHT 1997 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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