Should You Reveal Nonharmful Mistakes to Patients?

Batya Swift Yasgur, MA, LMSW

December 06, 2012

Is Keeping Mum Best for the Patient?

Physicians were divided about circumstances in which disclosure might or might not be in the best interest of the patient.

"We can't play God," one reader stated. "We are fallible and it's not for us to say what's in the best interest of the patient. The patient needs to know when an error has been made."

Other respondents presented a range of circumstances in which they believed that disclosure would be counterproductive and even harmful to the patient. They felt that disclosure might create undue anxiety, especially when a patient is a "worrier" or is under unusual stress, or has mental illness, psychological conditions, cognitive impairment, or other circumstances in which they lack the capacity to understand or integrate the information.

"I do not feel that 'coming clean' is always a winning proposition, with no harm at all," one reader wrote. Another added, "If the only effect of disclosure would be to generate anxiety or to burden the patient, or merely to relieve the practitioner's conscience, disclosure could be unethical."

Dr. Winslade concedes that "it's a judgment call. Some patients might feel, 'Why did you bother to tell me this?' Others appreciate the disclosure." He adds, "A physician who knows a patient might make the judgment that it would cause more harm to disclose -- but how well do you really know the patient? Can you be sure you're making the right call?"

Will You Enhance or Erode Trust?

Does disclosure of a nonharmful mistake threaten or build trust between the patient and the physician?

One reader advised, "Let sleeping dogs lie, as it would be better for the patient to trust the doctor than to ruin the relationship by revealing an inconsequential mistake that caused no harm." Another wrote, "Finding out about the mistake could cause the patient concern about my competence and undermine future adherence to treatment." A third stated, "Nothing is gained and trust is compromised."

Other respondents strongly disagreed. "As long as you are honest, the patient and their family will respect that you are telling them about the mistake, regardless if it led to harm or not," one reader wrote. Another concurred. "All of my patients have been appreciative of my honesty. Very few have wanted to move on to a new provider."

Dr. Winslade observes, "Disclosing a nonharmful mistake won't erode confidence in the physician. On the contrary, it will bolster trust by reassuring the patient that the doctor is truthful, even when not technically required to be.

Will Disclosure Land You in Hot Water?

Many survey respondents felt that unnecessary disclosure of nonharmful mistakes exposed the practitioner to legal action. "Our risk is soooooo great!" one reader exclaimed. "Why bother increasing our liability further?"

Another reader commented, "It sounds like political correctness run amok." A third wrote sarcastically, "Sure, let's advertise every conceivable thing that might have been done differently. And while we're at it, let's give the patient a copy of the Yellow Pages, with listings of ambulance-chasing attorneys."

Others disagreed. "The quicker you admit the mistake, especially a harmless one, the better the odds you never get in trouble for it," one reader wrote. Another added, "By law, we must disclose mistakes. Honesty is truly the best policy and I have never regretted being honest with patients or had any negative repercussions."

Several respondents pointed out that increased trust through full transparency mitigates against legal action, as patients who trust their physicians are less likely to bring a malpractice suit.

Dr. Winslade concurs. "As counterintuitive as it might seem, truthful disclosures, apologies, and appropriate acceptance of responsibility may decrease litigation and is known to decrease liability." As difficult as it might be to disclose, and as tempting as it might be to remain silent, "disclosing is ethical and preserves integrity."

How Should I Tell the Patient?

"Physicians need better training in how to approach patients about errors," one survey respondent noted. "I phrase my apology carefully so as to avoid unnecessary stress."

Other respondents agreed. "I would word the revelation carefully," one advised.

Several suggested that it's wise to learn more about apologizing to patients. Although many articles have focused primarily on errors where harm has occurred, many insights and suggestions can be applied to disclosure of nonharmful errors as well.

Conclusion

"Medicine, like all endeavors, is full of mistakes, ranging from trivial and insignificant to major," observed one survey respondent. "It is clear that the 'major' errors must be skillfully disclosed to the patient for the sake of transparency, trust, integrity, and ethical responsibility."

Trivial and insignificant errors, in which the patient has not received any incorrect treatments, have more leeway and subtleties. "The guiding principle is that candor, truthfulness, and disclosure should be favored over withholding information, but ultimately it's a judgment call," Dr. Winslade says.