Disclosing Medical Errors to Patients
Bringing physician practice closer to patient needs
Scholar: Thomas H Gallagher, MD
About one-third of patients have experienced a medical error in the previous two years. When Greenwall Faculty Scholar Alumnus Dr. Thomas Gallagher started his pioneering research on medical errors, patients usually were not told that they had been injured by an error. His work has led to increased disclosure of medical errors by physicians.
How do patients want doctors to respond to medical errors?
Dr. Thomas Gallagher and his research team carefully studied how patients would like their doctors to respond after a medical error occurs. Patients want physicians to:
- Disclose the error
- Take responsibility for the error and apologize
- Tell them what caused the error and what will be done to prevent similar errors in the future.
How do doctors actually respond to medical errors?
Dr. Gallagher’s team found that physicians agree that harmful errors should be disclosed to patients. However, when an error actually occurs, doctors often do not say explicitly that an error had occurred, why it had occurred, or how similar errors would be prevented in the future. Thus physicians support disclosure of errors in theory but in practice typically provide much less disclosure than patients would like (source, source).
What are the barriers to physician disclosure of errors?
Dr. Gallagher’s research refuted the conventional wisdom that lack of disclosure was due to fear of malpractice or lack of moral courage. Dr. Gallagher identified previously unreported barriers, including lack of confidence in their ability to carry out these difficult conversations, lack of institutional support, and shame or embarrassment (source). In addition, risk managers in hospitals presented mixed messages. Although they supported disclosure, risk managers were less likely to encourage doctors to apologize and discuss the cause of errors and the prevention of recurrences.
How can disclosure of medical errors be increased?
Disclosure of errors to patients is ethically important because it shows respect for patients and fosters trust. Dr. Gallagher and colleagues have worked on several fronts to increase physician disclosure of medical errors: (source):
- Suggesting how physicians can improve discussions of errors with patients.
- Strengthening support by hospitals, clinics, and risk managers for physician disclosure of errors
- Developing partnerships among health care institutions, insurers, and state officials to encourage physicians to disclose errors, while addressing physician concerns about disclosure.
The Greenwall Foundation provided an interdisciplinary incubator for Dr. Gallagher’s ideas.
The Greenwall Faculty Scholars Program in Bioethics supported Dr. Gallagher’s research on medical errors and provided a forum for him to discuss his ideas. He and fellow Greenwall Scholar Michelle Mello, a legal and policy researcher, developed the innovative and influential idea that health care institutions, physicians, and insurers can set up voluntary programs that address both medical errors and medical malpractice reforms. These programs disclose errors, apologize, and when appropriate offer patients compensation for injuries, without requiring them to sue (source). To read more about Greenwall Faculty Scholar Michelle Mello, click here.
Dr. Gallagher’s broad-ranging research has gained the trust of stakeholders.
In their research on errors, Dr. Gallagher and colleagues have moved from careful empirical studies to practical recommendations to close the gap between patient wishes for disclosure of errors and physicians’ and institutional practices. Their balanced, objective research has gained the trust of multiple stakeholders, including patients, physicians, risk managers, institutional leaders, insurers, and trial lawyers.
To link to Dr. Gallagher’s personal website at the University of Washington, click here.