MISTAKE DISCLOSURE
Most physicians' fears of being sued are exaggerated: the 200% overestimate by New York State physicians[1] of the risk of litigation is not unusual.
The standard Defence advice to cut off all communication under threat of suit appears to be widely practised as soon as a potential for litigation is recognised.
PRACTICE POINT Physicians fail to acknowledge and discuss most of their serious mistakes |
A "most serious mistake" questionnaire anonymously completed by junior hospital staff revealed that death of the patient had been the outcome in nearly a third. Nevertheless, only a half the house officers had discussed the mistake with the attending physician, and only a quarter disclosed it to patient or family[2].
| PRACTICE POINT Defence strategy encourages the very doctor-patient communication problems which motivate medical malpractice suits |
Even when explanations were given, litigating patients and relatives found them satisfactory less than 15% of the time[3].
Paradoxically, this communication failure encourages medical malpractice suit. Four main themes arose from a survey[3] of patients and relatives suing through 5 English Plaintiff medical malpractice firms. As well as Compensation, Accountability and Deterrence, clients wanted Explanation.
In a variety of studies[4], [5], major factors motivating litigation included poor relationship and communication with the physician, and poor delivery of information.
Almost all patients want their doctors to acknowledge errors, even minor ones[5a]. For moderate to severe mistakes, 12% of a US sample of patients said they would sue after physician disclosure, whereas the figure rose to 20% if they found out from elsewhere[5].
PRACTICE POINT No-fault Compensation does not address client needs to understand, and achieve closure |
Is a physician who makes a mistake ethically obligated to disclose?
The American College of Physicians' Ethics Manual[6] counsels error-telling "if such information significantly affects the care of the patients." An ethics review in The Canadian Medical Association Journal[7] recommends that physicians acknowledge their errors "but should not suggest they resulted from negligence".
Reality is that, whether voluntary or mandated, clinicians file incident reports for only a small percentage of actual errors[8],[9],[10].
Copyright © 2008 Electronic Handbook of Legal Medicine