Should You Reveal Nonharmful Mistakes to Patients?

Batya Swift Yasgur, MA, LMSW

December 06, 2012

Introduction

It's pretty clear that if you've made a terrible, harmful mistake, you should tell the patient about it. But what if the mistake is minor and harmless? Must you still "fess up"? 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?

More than 24,000 physicians answered this question in Medscape's 2012 Ethics Report. Many were adamant about maintaining honesty at all cost; others felt that opening up about insignificant oversights would cause patient distress for no useful reason. Some asked, "Why open a can of worms?"

Almost two thirds of the respondents (63%) said that it was never acceptable to cover up or avoid revealing a mistake, but 16% said that it was, and 21% said that it depends on the situation. These results are similar to those from Medscape's 2010 Ethics Survey in which 60% of respondents answered "No," 19% "Yes," and 21% "It depends."

"This is a very common question that all physicians must confront, since all of us make mistakes at some time or other," says Kenneth Prager, MD, Professor of Clinical Medicine and Director of Clinical Ethics, Columbia University Medical Center, New York, New York.

Survey respondents agreed. A typical comment was, "Physicians are human, and therefore mistakes are inevitable."

Not Revealing vs a Cover-up

Some respondents distinguished between "covering up" and "not revealing." Cover-up was unanimously regarded as wrong. One reader wrote, "Cover-up is simply a 'no' -- it's not merely hiding petty mistakes." Another stated, "There is never a justification for a cover-up."

"There's a major difference between covering up and not volunteering information after a mistake," says Dr. Prager. "Covering up is an act of wrongdoing that is always unethical, while there are shades and nuances to the question of whether to reveal an innocuous mistake to the patient if no harm ensued."

"I don't think it's ever OK to cover up or lie, but that's not the same as not revealing," one respondent declared. Another pointed out that covering up is "active," while nondisclosure is "passive," and added, "the former I can't condone but the latter could be reasonable -- depending on the circumstances."

William Winslade, PhD, JD, Professor of Medical Ethics, University of Texas Medical Branch at Galveston, disagrees, stating that nondisclosures and cover-ups should be avoided equally. "Full transparency trumps withholding information and not disclosing. I advise telling nothing less the whole truth, and nothing but the truth."