Truth or Consequences

While we are on the topic of medical errors, let’s see how doctors feel about disclosing them when the patient has not been harmed. Medscape recently surveyed doctors on this question and published the results in a provocative article by Gail Garfinkel Weiss entitled: ‘Some Worms Are Best Left in the Can’ — Should You Hide Medical Errors?” (A subscription is required, but it is free.)

To the doctors reading this, into which camp do you fall? To the patients reading this, what would you expect of your doctor in this kind of situation?

Some excerpts:

In response to the question “Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” 60.1% of respondents answered “no,” and the remaining respondents were almost evenly divided between “yes” (19%) and “it depends” (20.9%).

Professor Margaret R. Moon, MD, MPH, a pediatrician and faculty member at the Johns Hopkins Berman Institute of Bioethics at Johns Hopkins University, is squarely in the “no” camp. “Physicians have a duty to put the patient’s well-being first — specifically, before their own,” she says. “If patients don’t believe the physician will do that, the whole doctor-patient relationship falls apart. In some circumstances, a physician might believe that the disclosure of error might harm the patient more than benefit the patient. But because it’s difficult to know ahead of time how much a reasonable patient would want to know, erring on the side of disclosure makes the most sense.”

Among the comments on the “yes”‘ side:

  • If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes.
  • Why make a mountain out of a molehill if it will cause the patient more emotional upset than not saying anything?
  • I see no benefit in revealing mistakes of no consequence, like giving a patient Tylenol 650 mg instead of 325 mg.
  • Why shake the patient’s trust in the doctor for something that is irrelevant?

A somewhat different question about medical errors — “Are there times when it is acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?” — drew an almost unanimous response. A whopping 94.9% answered in the negative, 1.6% said “yes,” and 3.5% said “it depends.”

Some “yes” respondents hedged their bets, with one saying, “I would contact an attorney first.” Another, who had no such hesitation, said, “If the mistake has not progressed to harmfulness, then it’s essentially a non-issue. Treatment correction takes place and you move on.” Ditto for the respondent who endorsed nondisclosure “if the mistake appears in no way possibly significant now or in the future.”

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past three years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for
patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at
Not Running a Hospital.