Doctor holding a patient's hand
04 February 2016

Full Disclosure: A Handful Of Hospitals Are Making Docs Apologize

Apologizing is hard to do. That’s especially true for doctors, who often fear owning up to their mistakes because it can open them up to medical malpractice lawsuits.

Even doctors will admit that reticence is ingrained in the medical community – but that doesn’t mean they’ll admit to a mistake. Anywhere from 50% to 96% of all adverse events that occur in the US go unreported, according to public health researchers at Johns Hopkins University. The lack of transparency, no doubt intended to stall malpractice claims, is so bad that a majority of states have now passed laws preventing a physician’s apology from being admitted as evidence in court.

What Happens When You Make Physicians Accept Their Mistakes? Doctor holding a patient's hand

Major health organizations, including the National Quality Forum, have thrown their weight behind “full disclosure,” encouraging the idea that doctors should:

  • tell patients when errors occur,
  • explain why they happened,
  • describe what will be done to minimize the error’s effects,
  • accept responsibility and
  • offer an apology.

More than 10 years ago, Stanford University’s medical system decided to take an even more drastic step: offering money to patients injured by medical errors. Recent research has dispelled the myth that Stanford’s program, which makes doctors own up to their mistakes, actually reduces malpractice liability – but Stanford, along with a handful of other programs, is sticking to its guns.

Under the auspices of PEARL, its full disclosure program, Stanford is still providing injured patients with monetary settlements, and even waiving their healthcare costs in some cases. When family members are concerned about potential errors, they can call PEARL’s phone line 24 / 7 for a consultation. The hope, according to a recent report by the Wall Street Journal, is ultimately to “avoid costly litigation.”

Hospitals See Fewer Lawsuits

From the hospital’s perspective, PEARL is working out just fine. Malpractice lawsuits dropped by 50% from 2009 to 2014, and the system’s payouts in filed cases decreased by 40% compared to the previous five years. Patients seem to be benefiting, too, often receiving the compensation they need – without signing away the right to file a medical malpractice lawsuit in the future.

Similar “full disclosure” programs are being piloted at the University of Michigan and Boston’s Beth Israel Deaconess Medical Center, all operating under the aegis of the Collaborative for Accountability and Improvement, based at the University of Washington.

The Collaborative has partnered with malpractice insurance companies, which offer premium reductions to doctors willing to participate. It’s a system that seems to be paying off, not least for patients themselves, who are just appreciative to hear the words “I’m sorry.”

Are Doctors Open About Medical Mistakes?

Not really.

In a 2006 paper, researchers at the University of Washington School of Medicine commented on patients’ “desire to be told about medical errors” – and the often-reticent doctors who stand in the way of fulfilling that desire.

Hoping to find out just how much physicians are willing to disclose to their (injured) patients, the team sent out 2,637 surveys to doctors and surgeons in Missouri, Washington and Canada. More than half of the respondents said they would describe the “adverse event” to patients, but wouldn’t disclose the error that caused it. Only 42% were willing to admit that an error had occurred. Smaller percentages chose to say nothing. Less-apparent errors (the researchers sent out a list of scripted statements, asking the doctors how likely they would be to say each one) were more likely to be swept under the rug, while physicians suggested that major mistakes were more worthy of explicit explanations.

A similar survey, sent only to pediatricians, found doctors working with young children more willing to disclose their errors. 53% of the physicians said they would “definitely” cop to an error, but only 74% were willing to offer an apology. In their concluding remarks, the paper’s authors noted that pediatricians were more inclined to disclose serious errors when those errors were already apparent to a patient’s family.

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