PATIENTS WANT TO BE TOLD ABOUT MEDICAL ERRORS

Study in Annals of Internal Medicine examines consumers likely responses to disclosure

March 16, 2004

WORCESTER Mass. —Patients and their families want to be told if they have been the victim of a medical error, according to survey responses from nearly 1000 members of a New England health maintenance organization. “Our findings suggest that full disclosure after a medical error reduces the likelihood that patients will change physicians, improves patient satisfaction, increases trust in the physician, and results in a more positive emotional response. Full disclosure may also reduce the likelihood that patients will seek legal advice under some, but not all, circumstances, ” wrote Principal Investigator Kathleen Mazor, EdD, assistant professor of medicine at the University of Massachusetts Medical School (UMMS).

Explaining the genesis of the study entitled, “Health plan members’ views about disclosure of medical errors,” published in the March 16 issue of Annals of Internal Medicine Web jump icon, Dr. Mazor noted that, “Many have advocated for full disclosure by physicians, but we have not had a lot of empirical evidence about the benefits of such disclosure. Our study is the most substantive work to date in assessing health care consumers’ perceptions of, and responses to, disclosure of medical errors by physicians.”

Respondents were provided with one of four fictional medical error vignettes, two of which were life-threatening injuries, while two had less serious outcomes. These were followed by a simulated physician-patient discussion characterized by the physician either fully disclosing the incident, including assuming responsibility and apologizing, or providing limited information about it, for a total of eight different scenarios. Subjects were then asked to respond to questions about the scenario as if they were the patient or a family member.

Survey respondents reported being less likely to change physicians when the physician has fully disclosed what happened. However, even if the physician is completely forthcoming and apologetic about the error, many patients will probably still seek legal advice. Other key findings include:

  • Most patients want a full explanation of what happened, a sincere apology, and assurances that steps will be taken to prevent it from happening again;
  • Reactions were more positive when the injury was less serious and when the physician was more forthcoming about what had happened;
  • Although full disclosure after a medical error reduces the likelihood that patients will change physicians, improves patient satisfaction, increases trust in the physician, and results in a more positive emotional response, it does not guarantee any of these results; and
  • Full disclosure does not make it any less likely that the patient will seek legal advice in most conditions. Nor did it not make it more likely.

The study was funded by the U. S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, as part of its $165 million research initiative to improve patient safety. Mazor designed and conducted the survey with fellow investigators at UMMS and the Meyers Primary Care Institute (MPCI), a joint endeavor of the Fallon Foundation and UMMS. Other collaborators contributing to the study’s innovative design were Harvard Medical School and Harvard Pilgram Health Care of Boston, Massachusetts; HealthPartners Research Foundation of Minneapolis, Minnesota; and Lovelace Clinic Foundation of Albuquerque, New Mexico.

Since the survey was conducted among members of a managed care plan in a single geographic area, the authors caution against concluding the findings are valid for other populations “We’re looking forward to further investigations of more varied scenarios and interactions,” explained co-author Jerry H. Gurwitz, MD, the Dr. John Meyers Professor of Primary Care Medicine at UMMS and director of MPCI.

“Our findings add to the current knowledge of patients’ beliefs, preferences and attitudes about medical errors and disclosure, but also highlight the need for additional research,” concluded Mazor.

The Meyers Primary Care Institute is a joint endeavor of the Fallon Foundation and the University of Massachusetts Medical School, with a mission to promote primary care research and education.

The Fallon Foundation is a non-profit, charitable organization dedicated to serving its communities through health promotion, public education in health maintenance and disease prevention, and provision of health-care services. Since its establishment in 1998, the Fallon Foundation has given more than $2 million in donations, sponsorships, scholarships and support to communities throughout eastern and central

Massachusetts .

The University of Massachusetts Medical School is one of the fastest growing medical schools in the country, attracting more than $151 million in research funding annually.  A perennial top ten finisher in the annual US News & World Report ranking of primary care medical schools, UMMS comprises a medical school, graduate school of nursing, graduate school of biomedical sciences and an active research enterprise, and is a leader in health sciences education, research, and public service. UMMS is the academic partner of UMass Memorial Health Care, and a proud partner of the Fallon Foundation in the Meyers Primary Care Institute.  Visit UMMS online at www.umassmed.edu and the MPCI at www.umassmed.edu/meyers .

Contact: Sandra Gray, 508-856-2000