"I never thought it would happen to me." How Experiencing Medical Error has Changed Patients Interactions in Primary Healthcare

Presenter: Nancy C. Elder, MD, MSPH

Institution: University of Cincinnati, Ohio

Co-Authors: Jeff Jacobson, PhD; Therese Zink, MD; Lora Hasse, PhD; and Morgan Sill, BA

Introduction: Medical errors continue to be studied primarily from healthcare systems’ view. Little is known about patients’ experiences with and responses to medical errors. Purpose: To explore patients’ experiences with self-defined errors and preventable problems in primary care and to examine how these experiences have changed their interactions with the healthcare system.

Methods: Semi-structured interviews at participants’ home or work; five phone interviews. Participants: Using an administrative database, patients (grouped by race and age) were randomly selected from two university-affiliated family practices. Their phone numbers were called, and adults answering were asked: "Have you ever experienced a preventable problem with your primary care?; and "Would you discuss it further with a researcher?" A small number of patients were also solicited through a national patient safety advocacy group. Twenty-four local primary care patients and five national patient safety advocates were interviewed.

Instrument: A semi-structured interview was used to elicit responses from participants in describing their experiences with errors, their responses to their experiences, and changes made by them in interacting with the healthcare system. Interviews lasted 15 to 60 minutes each and were held until saturation for changes made by participants in interacting with the healthcare system was achieved.

Results: Interviews have been completed, transcribed, and analysis has begun. Initial analysis reveals that patients’ experiences include problems with office staff and systems, as well as problems with medical care. Participants’ reactions can be grouped into five categories: Avoid (stop going to the doctor); Accommodate (prepare for a long wait to be seen); Acquire knowledge (learn about your disease from family, friends, books, or the Internet); Actively communicate (ask questions of your doctor until you understand); and Advocate (insist on a second opinion). Many of these behaviors echo experts’ opinions, but some are original. Changes made in response to experiencing perceived error exhibit both constructive and destructive health patterns.

Discussion: Understanding how patients’ experiences were perceived preventable problems have changed their interactions is important if we want to become active participants in patient safety.