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Doctors should tell patients about mistakes made in their care, primarily because it is the right thing to do, says Albert W. Wu, M.D., M.P.H., of Johns Hopkins University, in a recent interview. Dr. Wu, whose work is supported in part by the Agency for Healthcare Research and Quality (HS11902), says further that the obligation to disclose is rooted in the trust that is at the core of the doctor-patient relationship.
Patients presume that their doctor will tell them the truth, and they feel angry and betrayed if not informed of a mistake. Paradoxically, disclosure of a mistake may strengthen the patient-doctor relationship, may improve patient-doctor communications, and may help patients gain more realistic expectations about medicine.
Dr. Wu agrees with the new patient safety standards established by the Joint Commission on Accreditation of Healthcare Organizations that became effective for hospitals July 1, 2001. They require organizations to inform patients, when appropriate, about the outcomes of care, whether anticipated or unanticipated. A practical reason for disclosure is that even if disclosure of unsuspected errors results in some settlements or lawsuits, it may actually reduce the risk of being sued or the payouts that result. This is because most patients or patients' families sue for one of three reasons: to get information that is not otherwise being revealed, because they are angry, or to ensure that the same thing won't happen again. Properly handled, disclosure can mitigate all of these concerns.
Many doctors want to be reassured that there is someone behind them—hospital administrators, risk management, defense counsel—to support their disclosure. Physicians in small hospitals in small communities point out that it is hard to keep anything confidential in their settings, and they worry about their reputations because of that. Others assert that disclosure will not be tenable until there is tort reform. Some hospitals regard disclosure as the right thing to do and say that they are ahead of their physicians who need more convincing. A nonpunitive disclosure policy might help convince them, says Dr. Wu.
More details are in "Reporting outcomes and other issues in patient safety," by Dr. Wu, in the April 2002 Joint Commission Journal on Quality Improvement 28(4), pp. 197-204.
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