Medical mishaps – to be revealed or not?

According to a recent research, doctors usually do not disclose the major medical mishaps if the error is not noticed by the patient.

The study was conducted on about 2700 American and Canadian doctors. It was found that 65% of them would surely reveal a serious mistake made during treatment. But there was a wide variation in when and how they disclosed it to the patients.

A doctor, who has made a noticeable error, is more likely to tell the patient than the one, who has made a less obvious one.

This study was conducted by the University of Washington and was published on 15th August 2006 in the Archives of Internal Medicine.

The doctors, on whom the study was conducted, were presented with 4 serious errors. Two of them were obvious errors, like a sponge left inside the patient during surgery. While the other two were less apparent ones, like an internal injury accidentally caused by a surgeon. When presented with the former type situation, 81% of the doctors said that they would disclose the matter to the patients while 51% were ready to use the word “error” in their explanation. But when presented with latter type situation, only 50% said they would reveal and only 32% would use the word “error” in their explanation.

"Basing disclosure decisions on whether the patient was aware of the error is not ethically defensible or consistent with required standards”, say the authors. They say that these figures are really a cause of concern.

Most of the doctors do not reveal due to the fear of legal action, says Dr Rosanna Capolingua, chair of the Australian Medical Association (AMA) ethics committee.

The situation was slightly better in Australia, as the fear was no so great there, says Dr. Capolingua and the only way to drastically reduce these figures was to eliminate the threat of legal action.

"In an ideal world, open disclosure is what we want," Dr Capolingua said.
"That way errors are not deemed to be due to malpractice and processes and systems can be put into place to ensure the error doesn't happen again."

In some situations a doctor may think it was in the patient's best interests not to reveal, she says.

"When the patient has not experienced adverse outcomes, the doctor may decide that it would not be of benefit to the patient," Dr Capolingua said.

"The doctor will sometimes think 'I don't want to worry them unnecessarily' and then choose on that basis not to say anything."