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Study Recommends Disclosing Medical Mistakes To Patients BALTIMORE, MD -- December 3, 1997 -- Physicians have an ethical obligation to tell patients about significant medical errors when such disclosure would benefit the health of the patient; would show respect for the patient's autonomy; or would be called for by principles of justice, according to researchers at the Johns Hopkins School of Public Health. Their examination of arguments for and against physician disclosure is published in the current issue of Journal of General Internal Medicine. The study analyzed ethical arguments for and against disclosure and offered practical suggestions about how to discuss mistakes with patients. "Disclosure should be the rule unless the physician has good reason to sacrifice the patient's autonomy," said lead author Albert Wu, MD, associate professor, Health Policy and Management, Johns Hopkins School of Public Health. Dr. Wu cited as an example a case where an already severely depressed patient would be incapacitated by the disclosure. The study, which concentrates on individual error as opposed to system error, also recommends that when a physician becomes aware of a harmful error made by another physician, the first physician should encourage the second to disclose the error to the patient. Currently, it appears that many mistakes are never disclosed. According to one study, house officers reported admitting serious medical mistakes to the attending physician only half the time and to patients or families less than a quarter of the time. Dr. Wu observes that disclosing a mistake can lead to the patient becoming angry and upset and filing a malpractice suit, which could result in the physician's malpractice premiums being raised. Referrals, hospital admitting privileges, preferred provider status, or even licensure could be jeopardized by disclosing mistakes. Nevertheless, the authors submit that disclosure may also be in the physician's best interest. If the physician decides to admit making an error, he or she can take steps to mitigate damage, or can take the initiative in recommending a fair out-of-court settlement. Truth-telling may strengthen the doctor-patient relationship and decrease the likelihood of a lawsuit. Disclosure can also confer psychological benefits on the physician, since the patient or family members may be the only ones who can absolve the physician of guilt. If, on the other hand, a physician does not admit a mistake, the mistake could come to light anyway. Any appearance of a cover-up only increases patient anger and litigiousness. "Begin by stating simply that you've made a mistake; describe in layperson's terms the decisions that were made, including those in which the patient participated; describe the course of events in detail; express personal regret and make a sincere apology," Dr. Wu said. He suggested that doctors should also elicit questions or concerns, and address them. "Try not to get defensive and see that financial amends are made," he said. E-mail this page to a friend or colleague! To print, use this version