System discourages physician disclosure

Disclosing medical errors made by physicians is extremely important, yet often quite difficult, maintain doctors at the University of Iowa's School of Medicine, Ames.

"It's a challenge to understand the diversity of reasons, both positive and negative, that affect a physician's willingness to disclose his or her own errors," says Lauris Kaldjian, associate professor of internal medicine and director of the Program in Biomedical Ethics and Medical Humanities.

"The physician's focus should always be on the patient but, at the moment of a medical error, we also must consider the professional who was involved in that error. Often, an error is not directly an individual person's fault, but a longstanding system-based problem.

"Yet, disclosing errors can be a very individual issue because sometimes only one person knows about it and, as a result, disclosure becomes an individual responsibility." Kaldjian points out that disclosing medical errors can contribute to three main goals of quality health care: patients deserve to know when things do not go the way they were expected; hospitals and clinics need to be aware of mistakes in order to improve patient safety; and sharing a medical mistake with colleagues can help educate other doctors so that they do not make the same error.

"Typically, these three goals are handled separately, and I believe this is a weakness in the way errors are addressed," Kaldjian states. "A better understanding of what helps or hinders error disclosure could result in ways to address these three goals together as part of one unified process."

A literature review revealed 91 factors involved in physician error disclosure, and focus group research added 27 more. "One comment from the focus groups clearly showed how emotionally traumatic errors are for physicians--by referring to that 'sinking feeling' when a doctor realizes that an effort to help someone has actually harmed them," Kaldjian notes. "Whatever else you say about medical errors, we need to remember that it's really difficult terrain."

The research also demonstrates that some physicians are frustrated with reporting systems set up by hospitals to encourage error reporting because there is little or no feedback. Some doctors say the "bottom line" in terms of positive motivation to report an error is the desire to be straightforward with patients. Yet, physicians also mention that talking about errors "doesn't earn you points," and that the culture of competition in medicine can discourage doctors from being honest about mistakes, even among colleagues.

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