THE LAST WORD

Taking the Fear Out of Error Disclosure

 

What if we could talk about medical mistakes without fear of judgment or punishment?

Fam Pract Manag. 2019 Nov-Dec;26(6):36.

Author disclosures: no relevant financial affiliation disclosed.

Our residency clinic admitted a patient to the family medicine inpatient service for sepsis, likely from pneumonia. On the day of admission, the patient was placed on intravenous (IV) antibiotics. His vital signs began to improve, and he was no longer febrile on day two of hospitalization. On day three, the patient developed a fever again. On day four, the patient was falling back into sepsis. The inpatient team reviewed the differential diagnosis list looking for something it might have missed. Why was the patient declining? A thorough review of the patient's medications revealed that antibiotics were not continued after day one. The inpatient team had to explain to the patient that it failed to notice that the antibiotics were not ordered. Once the antibiotics were resumed, the patient recovered.

EASING ERROR DISCLOSURE

Although medical errors cause approximately 251,000 deaths annually in the United States, less than 10 percent of medical errors are reported.1,2 Common barriers include fear of litigation, lack of peer support, inadequate training, and lack of a structured reporting system.3 Although it can be difficult, medical error disclosure to patients and families is ethical and can improve the patient-physician relationship and patient safety.4,5 Identifying errors is key to preventing their recurrence. To encourage proper reporting, physicians, colleagues, and organizations should take the following steps.

Physicians should model transparency by providing prompt, empathetic, and supportive communication with patients and families when a medical error occurs. Patients' perceptions of poor or insensitive communication may increase the likelihood of litigation; however, offering a direct apology can reduce the potential for litigation.4,6 Physicians should also offer to continue providing care to the patient or to facilitate a transition of care to a different physician or setting if appropriate.5

Colleagues should help foster an environment of support, devoid of

ABOUT THE AUTHORS

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Dr. Eniola is an assistant professor of family medicine at Cone Health Family Medicine residency program affiliated with the University of North Carolina in Greensboro, N.C....

Dr. Gambino is a third-year resident at Cone Health Family Medicine residency program.

Author disclosures: no relevant financial affiliation disclosed.

References

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1. Makary MA, Daniel M. Medical error — the third leading cause of death in the U.S. BMJ. 2016;353i2139....

2. Anderson JG, Abrahamson K. Your health care may kill you: medical errors. Stud Health Technol Inform. 2017;23413–17.

3. Poorolajal J, Rezaie S, Aghighi N. Barriers to medical error reporting. Int J Prev Med. 2015;697.

4. Perez B, Knych SA, Weaver SJ, et al. Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem. J Patient Saf. 2014;10(1):45–51.

5. AMA Code of Medical Ethics. Chapter 8.6: Promoting patient safety. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-8.pdf. Accessed Oct. 8, 2019.

6. Bell SK, White AA, Yi JC, Yi-Frazier JP, Gallagher TH. Transparency when things go wrong: physician attitudes about reporting medical errors to patients, peers, and institutions. J Patient Saf. 2017;13(4):243–248.

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