Medical errors: Doctors, risk managers take different approach to disclosure

Hospital risk managers are more likely to favor telling patients about mistakes, but physicians are more open to full apologies.

By — Posted March 12, 2010

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When things go wrong and patients are harmed, doctors and risk managers have reasons to fear telling patients what happened and offering an apology.

For a physician, the result could be the turmoil of a years-long medical liability lawsuit. For a risk manager, the hospital's bottom line could be hurt.

So how do these two groups compare when it comes to disclosure?

A new study, apparently the first to pose that question, found that physicians are more hesitant than risk managers to tell patients when an error occurs. But doctors are likelier than risk managers to use the word "error" in describing the mistakes and are quicker to say, "I'm sorry."

The study was published in the March Joint Commission Journal on Quality and Patient Safety (link).

Nearly 3,000 risk managers at health care facilities nationwide were surveyed in 2004 and 2005 for the study. More than 1,300 doctors in Washington state and Missouri were surveyed in 2003 and 2004.

Each group was faced with the same scenarios in which patients were seriously injured by errors -- a sloppily written prescription order, a missed lab test -- and asked what would be told to the patients.

Three-quarters of risk managers said they favored disclosure in the error scenarios, compared with half of physicians. But 56% of physicians said they would use the word "error" to describe the mistakes, compared with 42% of risk managers. Four in 10 doctors would offer a "full apology," compared with 21% of risk managers.

"Historically, the role of the risk manager has been perceived as really geared toward protecting the interests of the hospital, and part of that includes protecting the reputation and financial interests of the institution," said David J. Loren, MD, lead author of the study.

But the job description may be changing, Dr. Loren said. Health care risk managers are focusing more on error-reporting and preventing medical harm, opening them to the idea of disclosure.

"We're seeing a logical evolution of that role," said Dr. Loren, assistant professor of medicine in the Dept. of Pediatrics at the University of Washington School of Medicine.

Dr. Loren said physicians, risk managers and hospital administrators should work together, ahead of time, to create policies on what to tell patients when things go wrong. "This is a place where institutions will need to think ahead about how to solve that debate."

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