All Mistakes Are Not Created Equal
There is a spectrum of errors ranging from the most obvious adverse events, in which harm befalls a patient, to the most inconsequential, in which a trivial error was caught before the patient suffered ill effects or before even reaching the patient.
Simple clerical errors and documentation slip-ups were the types of inconsequential errors that Medscape readers felt were unnecessary to reveal. "If I document something in the wrong patient's chart and then delete it and record it in the correct patient's chart before any action was taken, there's been no harm done and it's absurd to notify either patient," one reader commented.
Another wrote, "If I ordered a complete metabolic panel when a basic metabolic panel was sufficient, that might be called a 'mistake,' but I wouldn't feel compelled to disclose it, as it is trivial and resulted in no harm to anyone."
Other examples of trivial mistakes included errors in prescription or treatment orders that were spotted by a nurse or pharmacist and corrected before reaching the patient. "If I called in a prescription to the pharmacy and the pharmacist's questions made me realize that I had miscalculated the dosage, I would be grateful for the correction but wouldn't feel that I needed to reveal this to the patient," Dr. Prager says. "It would certainly motivate me to be more careful next time," he adds.
Another survey respondent said, "I don't think I need to inform patients every time I misprint a script and catch it before it leaves the office, or change a CPT code."
This scenario differs from one in which the wrong medication or wrong dose has been administered, even if it did not harm the patient, Dr. Winslade points out. "In this case, it is appropriate to disclose the error, because the patient has actually received treatment."
Some respondents agreed. One commented, "Giving the wrong drug even if no harm results, is worth reporting for continued quality improvement."
Others took a different view. "I have accidentally given a larger-than-planned dose of narcotic to an anesthetized patient, resulting in an extra 15 minutes in the operating room awaiting return of respiratory function. No harm came to the patient other than the extra OR time. I don't think this has to be disclosed."
Another wrote, "If I put a screw in the bone in the wrong place during surgery, then I noticed and changed the placement and all was well -- these mistakes happen all the time. Telling the patient would cause unneeded worry and concern."
Is It Really a Mistake?
What constitutes a mistake can sometimes be subjective. One survey respondent commented, "What one physician perceives as a mistake, another may perceive as an expected event. For example, in the operating room, a small serosal tear requiring a suture may occur -- a very common occurrence with adhesions. I may not tell the patient about this, as it is not likely to cause a problem. Does the frequency of occurrence make a difference in whether it's seen as a 'mistake'? This depends on the doctor's perception."
"Mistakes" like these are sometimes viewed as simple events that take place in the course of ordinary practice. "A lot of my colleagues dismiss errors as 'occurrences' and not 'mistakes,'" one respondent reports. "They believe that if it causes no harm, it was just an 'event' and there is no point in revealing it. Their viewpoint is 'no harm, no foul.'"
Dr. Winslade strongly disagrees. "'No harm, no foul' is a misguided theory here, because it is the patient's right to be informed of any intervention administered in the course of treatment that could have caused harm.
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Cite this: Should You Reveal Nonharmful Mistakes to Patients? - Medscape - Dec 06, 2012.