Introduction
No one likes to admit to being wrong, or to spilling the beans in delicate situations. For on-the-job physicians, especially, the consequences of making an error or speaking out of turn -- also known as violating HIPAA rules -- can range from nonexistent to a slap on the wrist to lawsuit that carries both financial and professional costs.
Consequences aside, from a strictly ethical perspective, if a patient doesn't realize that his physician made a mistake, should the physician fess up? And to what lengths must a physician go to protect patient privacy and doctor-patient confidentiality?
Evidence of the complex prisms through which physicians view these issues was apparent in the replies to four questions asked in Medscape's exclusive ethics survey. More than 10,000 physicians responded to the survey in 2010.
Mistakes That Don't Harm Patients
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?
Another doctor responded "yes" in the belief that "as soon as patients hear of a mistake they start imagining problems that likely wouldn't exist if they hadn't known of the mistake." And one opined, "Some worms are best left in the can."
Several who answered "it depends" mentioned the need for physicians to consider how knowing about a mistake -- even a benign one -- would affect individual patients. One noted, "It depends what the mistake is and whether revealing a harmless error would raise patient anxieties in such a way as to compromise treatment." Similarly, a respondent wrote, "If the mistake would not cause harm to the patient and revealing the mistake would cause irreparable harm to the physician-patient relationship, the act of revealing the mistake needs to be considered carefully."
Some "it depends" respondents hedged their answers by noting that concealing mistakes, even for benign reasons, puts physicians in uncertain ethical territory. For example, "If a patient is a worry-about-everything type and the mistake absolutely would not cause any harm, I would consider not telling the patient. However, in most cases I am sure that being truthful is best in the end."
The "no" contingent cited various reasons, including:
Cover-ups are never okay.
That kind of thing always comes back to hurt you.
If a mistake has been made, the patient deserves to be aware. If a wrong medication was given, even if it did not cause harm, the physician should reveal the mistake, apologize, and explain what corrections have been made. It is simply easier this way and avoids the need for explanations in the future.
If patients later learn that the truth has been kept from them, their trust will never be the same. Cover-up is worse than the mistake and has greater repercussions in the long run.
Medscape Medical Ethics © 2011 WebMD, LLC
Cite this: Gail Garfinkel Weiss. 'Some Worms Are Best Left in the Can' -- Should You Hide Medical Errors? - Medscape - Jan 04, 2011.
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