Clinical Outcomes, Disclosing Unanticipated: A Resource Guide for Family Physicians (Position Paper)

Health care literature is replete with studies documenting the occurrence of clinical errors in hospital and office based medical practice. It is widely accepted that patients should be informed when errors occur. Standards promulgated by the Joint Commission make this an explicit requirement in the hospital setting. The question physicians must ask today is not whether to disclose a clinical mistake, but how to share the information. Many physicians are not familiar with the results of coordinated efforts by some health care organizations to institutionalize the disclosure of medical mistakes. By and large, these efforts have been quite positive in helping patients come to grips with the clinical consequences of a clinical error, aiding physicians who may be plagued by guilt following the occurrence of an error and in ameliorating liability costs. A number of organizations, such as Sorry Works! (described below) have been created to assist physicians to communicate effectively with patients under the emotionally laden circumstances of a clinical error.

The Bibliography and Resource List which follows is meant to provide the busy clinician a reference point for learning more about approaches to disclosing medical mistakes. The articles and resources below are best explored before an unfortunate circumstance makes the need compelling. However, they will also be useful for those reaching out for ‘just-in-time’ knowledge. This resource listing is meant to be a useful, but not an exhaustive, guide to the literature on this subject and there is little doubt that additional resources will constantly be appearing.



Sorry Works: The Sorry Works! Coalition is a nationwide organization of doctors, lawyers, insurers, and patient advocates dedicated to promoting full-disclosure and apologies for medical errors as a “middle ground solution” to the medical liability crisis. It has published white papers and protocols for addressing medical errors and it is a major sponsor of legislation at the state level. It has an informative web site at

Articles and Publications:

Beaulieu-Volk D. The right and wrong way to talk to patients about adverse events. Med Econ. 2014 Jun 10;91(11):52-5. Full text available at:

Brunken JD. Disclosing adverse events: 3 steps physicians should take. Med Econ. 2016 Jan 10;93(1):53.

Bismark MM, The power of apology, N Z Med J. 2009;122(1304):96-106. Abstract at

Cherry RA, Marcus L, Dorn B. Reporting adverse events to patients: a step-by-step approach, Physician Exec J. 2010;36(3):4-6, 8-9.

Fein SP, Hilborne LH, Spiritus EM, et al. The many faces of error disclosure: a common set of elements and a definition. J Gen Intern Med. 2007;22(6):755-761.

Gallagher TH. Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases. Chest. 2009; 136(3):897-903. Abstract available at:

Gallagher TH, Studdert D, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med. 2007;356(26):2713-1719.

Gaskill JR. Disclosing medical mistakes: a communication management plan for physicians. Perm J. 2013 Fall;17(4):94. Full text available at:

Ghalandarpoorattar SM, Kaviani A, Asghari F. Medical error disclosure: the gap between attitude and practice. Postgrad Med J. 2012 Mar;88(1037):130-3 Abstract available at:

Iedema R, Allen S. Anatomy of an incident disclosure: the importance of dialogue. Jt Comm J Qual Patient Saf. 2012 Oct;38(10):435-42. Abstract available at:

Iedema R, Allen S, Britton K, et al. Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study. The BMJ. 2011;343:d4423. Full text available at:

Kachalia A, Bates DW. Disclosing medical errors: the view from the USA. Surgeon. 2014 Apr;12(2):64-7. Abstract available at:

Levinson W. Disclosure of Medical Error. JAMA. 2016;316(7):764-765. Full text available at:

Lu DW, Guenther E, Wesley AK, Gallagher TH. Disclosure of harmful medical errors in out-of-hospital care. Ann Emerg Med. 2013 Feb;61(2):215-21. Abstract available at:

Lambert BL, Centomani NM, Smith KM, Helmchen LA, Bhaumik DK, Jalundhwala YJ,

McDonald TB. The "Seven Pillars" Response to Patient Safety Incidents: Effects on Medical Liability Processes and Outcomes. Health Serv Res. 2016 Dec;51 Suppl 3:2491-2515.Abstract available at:

McDonald TB, Helmchen LA, Smith KM, et al. Responding to patient safety incidents: the "seven pillars." Qual Saf Health Care, 2010;19(6):e11.  (

O'Connor E. Disclosure of patient safety incidents: a comprehensive review. International Journal for Quality in Health Care, 2010;22(5):371-379.

Patel N. I'm sorry and an unexpected response. J Gen Intern Med. 2012 Jul;27(7):882-3. doi: 10.1007/s11606-011-1897-0. Full text available at:

Perez B, Knych SA, Weaver SJ, Liberman A, Abel EM, Oetjen D, Wan TT. Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem. J Patient Saf. 2014 Mar;10(1):45-51. Abstract available at:

Petronio S, Torke A, Bosslet G, Isenberg S, Wocial L, Helft PR. Disclosing Medical Mistakes: A Communication Management Plan for Physicians. The Permanente Journal. 2013;17(2):73-79. Full text available at:

Petronio S, Helft PR, Child JT. A Case of Error Disclosure: A Communication Privacy Management Analysis. Journal of Public Health Research. 2013;2(3):e30. Full text available at:

Roberts RG, The art of apology: when and how to seek forgiveness. Fam Pract. Manag. 2007;14(7):44-49.

Robbennolt, JK. Apologies and medical error. Clin Orthop Relat Res. 2009. Feb;467(2): 376-382. Full text available at:

Rocke D, Lee WT. Medical Errors: Teachable Moments in Doing the Right Thing. Journal of Graduate Medical Education. 2013;5(4):550-552. Full text available at:

Sorensen R, Iedema R., Piper D, Manias E, Williams A, Tuckett A. Disclosing clinical adverse events to patients: can practice inform policy? Health Expect. 2010;13(2):148-159. Abstract at

Weiss PM, Miranda F. Transparency, apology and disclosure of adverse outcomes. Obstet Gynecol Clin North Am. 2008;35(1):53-62, viii. Abstract at

White AA, Bell SK, Krause MJ, et al. How trainees would disclose medical errors: educational implications for training programs. Med Educ. 2011;45(4):372-380. Abstract at

(March Board 2006) (2017 April BOD)