'Some Worms Are Best Left in the Can' -- Should You Hide Medical Errors?

Gail Garfinkel Weiss, MSW, BBA

Disclosures

January 04, 2011

In This Article

Mistakes That Might Harm Patients

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."

Those who answered "it depends" included a physician who wrote, "If revealing the mistake won't change the management and has not yet caused any harm, I think a 'wait and see' approach is okay." Another would hold back "only if revealing the mistake would cause more harm to the patient, ie, make him stop all needed treatment."

The "no" responders were having none of that. Their replies ranged from "Patients have the right to know what went wrong, as well as what went correct in their treatment," to "Painful and awkward to be sure, but nothing compared to the potential blowback," to "Once you break the rule of truth, you as a physician might as well quit."

In a more expansive rejoinder, a physician wrote, "Once a mistake is discovered it must be revealed, root cause analysis performed, and patient informed of the mistake, its consequences if any, and plans to prevent a recurrence."

Is It Self-Serving to Let Sleeping Dogs Lie?

Dr. Moon agrees that when a mistake has the potential to cause harm, disclosure is the way to go. A "let sleeping dogs lie" strategy, or the aforementioned "wait and see" approach may be in the physician's best interests, she says, but it's rarely in the patient's best interests -- especially if it was a clinical error, because clinical errors affect the patient's body.

In Dr. Moon's view, disclosure is important at the outset, especially if the patient needs to be made aware of possible consequences. And the error should be spelled out in the medical record for the benefit of the patient and clinicians who see the patient at a later date.

"Patients accept medical errors with more tolerance than most physicians think, especially if the mistakes aren't egregious," Moon says. "Medicine is complicated and hard, and mistakes happen. It's in no one's best interests to pretend otherwise. Accepting mistakes is part of clinical practice, and dealing with them honestly and openly is of great benefit to the doctor-patient relationship and the therapeutic alliance."

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