To Err Is Human, for a Pathologist to Apologize Is Uncommon

Neil Osterweil

October 07, 2015

NASHVILLE, Tennessee — Although most pathologists will admit to having some involvement in a pathology error, many of them are ill-prepared to communicate with the patients who suffer the consequences, according to results from an anonymous survey.

"Even though pathologists don't interact directly with patients, we make errors just like in any other field of medicine," David Cohen, MD, from the Houston Methodist Hospital, told Medscape Medical News.

In such cases, "patients frequently say they want a sincere apology, they want a clear explanation of what happened, and they want an explanation of how it will be prevented in the future," said Dr Cohen. However, pathologists usually defer the "mea culpas" to their provider colleagues.

"How are you supposed to do those things — give an apology and explain in full detail what happened — if you're completely giving responsibility for error disclosure to someone else?" he asked.

Dr Cohen addressed the ethical, medicolegal, and professional implications of error disclosure here at the College of American Pathologists 2015 Meeting.

He and his colleagues developed a multiple-choice survey to assess attitudes and experiences related to the disclosure of medical errors.

Disclosing Medical Errors

They invited attendees at a state pathology conference, attendees at a nationwide conference of pathology residents, and members of the program directors section of the Association of Pathology Chairs to complete the survey anonymously.

Of the 106 respondents, 103 (97%) acknowledged being involved in a minor or serious error, but only 39% of practicing pathologists and 13% of trainees said they knew whether the error had been conveyed to the patient. And only 11% of practicing pathologists and 0% of pathology trainees reported that they had participated directly in disclosing a serious error to a patient.

In addition, only 40.7% of practicing pathologists and 13.5% of trainees said they were aware of their hospital's error disclosure policy, and even fewer — 18.5% and 1.9%, respectively — reported knowing whether the state in which they worked had an apology law.

And 58.5% of practicing pathologists and 51.9% of trainees reported that they had had no training in the disclosure of medical errors.

Nobody goes to work saying, 'I want to kill a patient.'

There is some indication that things are starting to change. Although just 5.7% of the more seasoned practicing pathologists reported having received training in the disclosure of errors when they were in medical school, 30.8% of the more recently schooled trainees said they had been drilled in error reporting.

This issue is "one that I, as someone who was a clinician before I became a pathologist, have never been afraid to address," said Melissa Austin, MD, from the Walter Reed Military Medical Center in Bethesda. Maryland. "But I know it causes a lot of our trainees a significant amount of angst to have to communicate any kind of error to the clinician or the patient."

"I think that this works only if the institution sets a culture that embraces openness, disclosure, and nonpunitive handling of errors," she told Medscape Medical News.

Nobody goes to work saying, "I want to kill a patient.' You go to work, you do the best you can, and you will make errors," she said. "But it's important to train like you train to fight — you hope it never happens, but when it does happen, you have to deal with it."

This study was internally supported. Dr Cohen and Dr Austin have disclosed no relevant financial relationships.

College of American Pathologists (CAP) 2015 Meeting. Poster abstract 158.


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