To tell the truth: Ethical and practical issues in disclosing medical mistakes to patients

Department of Health Policy and Management School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md., USA.
Journal of General Internal Medicine (Impact Factor: 3.45). 01/1998; 12(12):770-5.
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Available from: Albert W Wu, Feb 18, 2015
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    • "A mistaken decision”[3]. Wu and colleagues [4] define medical error as “a commission or an omission with potentially negative consequences for the patient that would have been judged wrong by skilled and knowledgeable peers at the time it occurred, independent of whether there were any negative consequences.” "
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    ABSTRACT: To evaluate the common sources of diagnostic errors in emergency ultrasonography. The authors performed a Medline search using PubMed (National Library of Medicine, Bethesda, Maryland) for original research and review publications examining the common sources of errors in diagnosis with specific reference to emergency ultrasonography. The search design utilized different association of the following terms : (1) emergency ultrasonography, (2) error, (3) malpractice and (4) medical negligence. This review was restricted to human studies and to English-language literature. Four authors reviewed all the titles and subsequent the abstract of 171 articles that appeared appropriate. Other articles were recognized by reviewing the reference lists of significant papers. Finally, the full text of 48 selected articles was reviewed. Several studies indicate that the etiology of error in emergency ultrasonography is multi-factorial. Common sources of error in emergency ultrasonography are: lack of attention to the clinical history and examination, lack of communication with the patient, lack of knowledge of the technical equipment, use of inappropriate probes, inadequate optimization of the images, failure of perception, lack of knowledge of the possible differential diagnoses, over-estimation of one's own skill, failure to suggest further ultrasound examinations or other imaging techniques. To reduce errors in interpretation of ultrasonographic findings, the sonographer needs to be aware of the limitations of ultrasonography in the emergency setting, and the similarities in the appearances of various physiological and pathological processes. Adequate clinical informations are essential. Diagnostic errors should be considered not as signs of failure, but as learning opportunities.
    Critical ultrasound journal 07/2013; 5 Suppl 1(Suppl 1):S1. DOI:10.1186/2036-7902-5-S1-S1
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    • "Errors are common in medicine. Fortunately, most errors do not result in significant harm [6]. Unanticipated outcomes are not necessarily the result of medical error. "
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    ABSTRACT: Medical errors became a common topic of conversation with the release of the Institute of Medicine's "To Err Is Human" in November of 1999. This release reported that as many as 98,000 people die each year from inpatient medical errors. Putting this into perspective, deaths from medical errors surpassed deaths from breast cancer, motor vehicle accidents, and AIDS. Furthermore, medication errors account for more deaths annually than workplace injuries. This article addresses communication of adverse outcomes to patients (disclosure) through transparency and apology.
    Obstetrics and Gynecology Clinics of North America 04/2008; 35(1):53-62, viii. DOI:10.1016/j.ogc.2007.12.007 · 1.38 Impact Factor
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    • "There is widespread recognition that disclosing adverse events to patients is the ethically proper response (Cantor et al, 2005; Rosner et al, 2000; Sweet and Bernat, 1997; Wu et al., 1997). Clinicians, however, face a difficult dilemma when deciding whether and how to disclose a harmful error to a patient. "
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    ABSTRACT: Introduction Since the Institute of Medicine (1999) published To Err is Human in 1999, many publications have discussed the need for different approaches to disclosing adverse events to patients, and the need to create a culture of safety within the healthcare system. Many of these articles begin with a clinician discussing an adverse event in which they were involved (Richards, 2000; Wu, 2001; Payne, 2002). Each individual story provides the medical and policy communities with an isolated view of an adverse event and the disclosure or non-disclosure of that event to the patient. There have also been research papers in the legal and medical literature that are designed to address specific areas of disclosure (Popp, 2003; Wu, 2000). Error disclosure is now required by ethicists, professional organizations and increasingly by regulatory bodies. The goal of this chapter is to combine these accounts, stories and recommendations into a coherent roadmap for guidance in the field of disclosure. To accomplish this goal, we will begin by defining key terms, and will provide evidence that disclosure is a central part of fostering a safety culture. We will examine physician report cards and their relationship to disclosure policies. We will address the significant gap that exists between the principle of error disclosure and actual practice. Although most of the literature on disclosure is based on in-patient adverse event occurrences, most of healthcare occurs in the ambulatory setting. © Cambridge University Press 2007 and Cambridge University Press, 2009.
    Informed Consent and Clinician Accountability: The Ethics of Report Cards on Surgeon Performance. edited by Steve Clarke and Justin Oakley (eds.), 12/2007; Cambridge University Press 2007..
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