Paper guides physicians' disclosure of colleagues' errors

October 30, 2013, University of Washington

Physicians' disclosure of errors has been studied more in the past decade than ever before, spurring rationales and guidelines for acknowledging one's own mistakes with patients. Relatively little, though, has spoken to how physicians should broach mistakes made by colleagues.

"What do I do when it's somebody else's error and I have to decide whether to say anything to the patient?"

It's the question Thomas Gallagher has fielded most often at the hundreds of error-disclosure seminars he's led. Gallagher, a general internist and UW professor of medicine and of & humanities, is lead author of "Talking with Patients about Other Clinicians' Errors," an article to be published Oct. 31 in the New England Journal of Medicine.

At its core, he said, the paper attempts to reframe what being a "colleague" means.

"What do professionalism and collegiality really call on us to do? The historical norm is that being a good colleague means not saying anything, having their back, when you think they've made a mistake. We're asking people to turn toward their colleagues in those instances," Gallagher said.

Barriers to these conversations abound: the lack of confidence in one's disclosure skills, mixed signals from healthcare institutions and malpractice insurers, and potential repercussions such as being labeled disloyal, losing referrals and the specter of litigation all contribute to the culture of looking away from problems.

"Part of the change that we and others are working toward is to take away that sense of shame and stigma when care has not gone well, and make it the norm to talk with one another about quality problems," Gallagher said. "Everyone makes , so the norm should not be, 'How do I keep this to myself?'"

Broaching a potential error with a colleague is more complex than a direct "mea culpa" to a patient. Beyond the confrontation itself, there are questions of whether and when to involve other clinicians or institutional administrators. The authors warn against speculation and give guidance to fact-finding without provoking defensiveness.

Institutions should provide leadership in bringing about these conversations, the authors wrote, by strengthening "atmospheres of trust in which people are encouraged, even rewarded, for providing essential safety-related information." Many have adopted disclosure-coaching programs to help facilitate peer-to-peer discussions, the paper said.

The movement to transparency is grounded not only in an ethical obligation to patients, but also in the mandate to improve the quality of healthcare.

"That we struggle to ask colleagues to have discussions when care has not gone well is a major drag on our ability to learn from problems and prevent recurrences. Doctors are going to have to get much better with having that awkward conversation. Institutions need to figure out what they can do to support that," Gallagher said. "Being transparent is really a collective responsibility."

Explore further: New study the first to look at nursing error disclosure in nursing homes

Related Stories

New study the first to look at nursing error disclosure in nursing homes

November 4, 2011
Nurses have an obligation to disclose an error when one occurs. While errors should be avoided as much as possible, the reality is the health care delivery system is not and will never be perfect; errors and adverse events ...

Communication factors aid cancer diagnosis disclosure

October 14, 2013
(HealthDay)—Ensuring disclosure of a gynecological cancer diagnosis takes place in a private setting and that the conversation lasts for more than 10 minutes improves patient satisfaction, according to a study published ...

An end-of-life 'conversation guide' for physicians to speak with patients

July 15, 2013
How does a doctor tackle the delicate issue of end-of-life care planning with a patient?

Emergency physician's loss sparks advocacy

December 4, 2012
Jonathan Welch, MD, a physician in the Department of Emergency Medicine at Brigham and Women's Hospital, never thought his family would be part of a medical error. But when his mother's battle with cancer took a sudden turn ...

High out-of-pocket costs called a hidden 'side effect' of treatment

October 16, 2013
(HealthDay)—Doctors should consider the "toxic" effects of medical debt as much as any other side effect when discussing treatment options with patients, a trio of physicians contends.

Recommended for you

Little difference between gun owners, non-gun owners on key gun policies

May 17, 2018
A new national public opinion survey from the Johns Hopkins Bloomberg School of Public Health finds widespread agreement among gun owners and non-gun owners in their support for policies that restrict or regulate firearms.

Giving employees 'decoy' sanitizer options could improve hand hygiene

May 17, 2018
Introducing a less convenient option for hand sanitizing may actually boost workers' use of hand sanitizer and increase sanitary conditions in the workplace, according to findings in Psychological Science, a journal of the ...

Research shows that sexual activity and emotional closeness are unrelated to the rate of cognitive decline

May 16, 2018
Older people who enjoy a sexually active and emotionally close relationship with their partner tend to perform better at memory tests than sexually inactive older adults on a short-term basis, but this is not the case over ...

New study reveals how electronic health records can benefit clinical trials

May 16, 2018
The study entitled "Long term extension of a randomised controlled trial of probiotics using electronic health records" led by researchers in the Swansea University Medical School and the College of Human and Health Sciences, ...

Latest research strengthens case that early exposure to pollution affects long-term health

May 16, 2018
Research led by the University of Southampton has shown increasing evidence that exposure to air pollution in early life has detrimental long-term health consequences.

Researchers find a connection between left-handedness and low birth weight

May 15, 2018
A team of researchers from Finland, the Netherlands and Japan has found a connection between left-handedness and low baby birth weight. In their paper published in Proceedings of the National Academy of Sciences, the group ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.