Are Interns Really Willing To Disclose Medical Errors?

In a recent email conversation with Paul Levy, he shared with me a very exciting study, Changes in intern attitudes toward medical error and disclosure. I mentioned that the results of the study, while encouraging on one level, need to be looked at with a cautious mindset. The actual act of disclosing an error to a patient (behavior) is much different from a belief about doing the same (attitude). In our hearts, we all want to do the right thing–but it is our actions or behaviors that define the ultimate outcome. More of our conversation can be found in Paul’s post, Attitudes are one thing, behavior is another.

We believe that disclosure and apology in the face of a medical error is the right thing to do, but in actuality, how many of us really do so? In my personal experience with UIC’s disclosure and rapid remedy program (The Seven Pillars), caregivers don’t disclose – organizations disclose.  Without leadership/board buy-in and medical malpractice carrier support, the right attitude about disclosing doesn’t become behavior. In a previous post, Can We Be Honest When Medical Errors Occur, Part 2, I share a medical error case I was involved in many years ago and mention the very real barriers that prevent caregivers (who believe it is the right thing to do) from being open and honest when care unintentionally causes harm (the behavior), such as:

  1. Damage to one’s reputation
  2. Loss of license or career
  3. Fear of litigation
  4. Culture that blames individuals when system errors occur (“Shame and Blame”)
  5. Loss of control
  6. Lack of training on how best to handle these difficult conversations
  7. Uncertainty/Unknown

These barriers have prevented very good people from doing what they believed was the right thing to do. Today, a growing number of health systems across the country are slowly putting programs in place that encourage residents and interns to act on the changing attitudes Varjavand et al mention in their study above. But it is a systems effort, and the conflict between attitude and behavior will continue to exist until more health systems realize that disclosure, and programs that teach how to do so in the best interest of both patient and caregiver, become widespread.

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