Disclosure of Medical Errors

Abstract

1. Sophie K. Shaikh, MD, MPH* 2. Sarah P. Cohen, MD*,† 1. *Department of Pediatrics and 2. †Department of Internal Medicine, Duke University Hospital, Durham, NC Medical errors are alarmingly frequent, with as many as 250,000 deaths per year being attributable to medical error. This makes medical error potentially the third most common cause of death in the United States. Approximately 1% to 3% of pediatric hospital admissions are complicated by medical error. Medication errors are frequent in children in part due to weight-based dosing, with more than 5% of medication orders containing an error. Although not every error causes death, medical errors can significantly affect the course of a patient’s illness and can cause significant morbidity and alter the relationship between the family and the physician. With medical errors occurring in all health-care settings, no provider can consider themselves immune. As such, every physician, including pediatricians, should be prepared to disclose errors. Since the Institute of Medicine’s 1999 publication of To Err Is Human: Building a Safer Health System,” there has been a shift in response to medical errors from a deny and defend mindset to a philosophy of transparency. Disclosure refers to the process of communicating with a patient about an adverse event. Most physicians and professional organizations agree that there is an ethical and moral obligation to disclose when an adverse event results from a medical error, based primarily on the concepts of autonomy and justice. Failure to disclose affects a patient’s autonomy to make informed decisions about his or her health. The principle of justice dictates that patients should be able to seek reasonable compensation for harm. Failure to disclose erodes trust in the physician-patient relationship; studies have shown that disclosure actually improves this relationship after an error. Research also confirms that …

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