Physicians, like other human beings, sometimes make mistakes. Purely based on the number of decisions they need to make, doctors
actually make more mistakes than most people.
This is the first of a two-part column looking at studies that examine physician errors, responses to them and their consequences.
Full disclosure
Because many errors go unrecognized or unreported, it's difficult to compile accurate statistics. Some variables include the
seriousness of the error, the physician's personality and the quality of the physician-patient relationship. One recent study surveyed 538 faculty, residents and medical students and asked them about their likelihood of reporting various
clinical error scenarios. Here's what the study, titled "Disclosing medical errors to patients: attitudes and practices of
physicians and trainees," reported:
"Almost all faculty and residents responded that they would disclose a hypothetical error resulting in minor (97%) or major
(93%) harm to a patient. However, only 41% of faculty and residents had disclosed an actual minor error (resulting in prolonged
treatment or discomfort), and only 5% had disclosed an actual major error (resulting in disability or death). Moreover, 19%
acknowledged not disclosing an actual minor error and 4% acknowledged not disclosing an actual major error. Experience with
malpractice litigation was not associated with less actual or hypothetical error disclosure. ... Several attitudes were associated
with greater likelihood of hypothetical disclosure, including the belief that disclosure is right even if it comes at a significant
personal cost."
So, that study showed that physicians might say that they'll report errors, but are not as likely to do so when one actually
occurs. The studies also showed that more experienced doctors are often more willing to disclose errors to patients. Finally,
fear of malpractice litigation did not seem to factor into the responses of the doctors surveyed.
How errors affect doctors emotionally
Another recent study investigated ways in which errors committed by doctors affected them emotionally. A survey of 3,171 physicians
in internal medicine, pediatrics, family medicine and surgery examined how errors affected what the authors called five "work
and life domains." What they found was that the physicians reported "increased anxiety about future errors (61%), loss of
confidence (44%), sleeping difficulties (42%), reduced job satisfaction (42%) and harm to their reputation (13%) following
errors."
In this study, published in last August's The Joint Commission Journal on Quality and Patient Safety, characteristics of physicians that lead to increased likelihood of being distressed after serious errors were: dissatisfaction
with error disclosure to patients, perceived greater risk of being sued and spending more than 75% of one's time in clinical
practice.
These results would seem to me to make these physicians even more prone to committing future errors, and even less likely
to report them. One-third of the surveyed doctors were involved with "near misses," and even they reported increased stress
after those incidents. Only 10% felt that healthcare organizations adequately supported them in coping with error-related
stress.
How forgiving are patients?
It's anecdotally thought among doctors that the best way to avoid malpractice suits is to have honest relationships with patients
that facilitate clear communication. One recent study looked at what factors are actually involved in patients' decisions
to forgive doctors' clinical errors.
The authors mailed a questionnaire to 1,500 randomly selected health plan members – 1,000 responded. Questionnaire items assessed
the likelihood of forgiveness following 12 different medical error scenarios. They found that the "respondents were most likely
to forgive a physician if the patient failed to provide complete information (93% would or might forgive) and least likely
to forgive if the error was due to efforts to keep costs down (11% would or might forgive). Most respondents would not forgive
a physician when the physician was tired or distracted (68%), was incomplete in data collection (76%), lacked knowledge (78%)
or failed to follow up (85%). Men were more likely to forgive than women; the most educated respondents were most likely to
forgive."
These results essentially say that patients will be less forgiving when they sense less-than-adequate physician care or cost-cutting,
and will be more forgiving when the patient contributes to the error by not providing the doctor with a good history.
Part two will further examine patients' attitudes and feelings on this topic, as well as what pharmaceutical representatives
can do to help improve this problem.
