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How surgeons disclose medical errors to patients: a study using standardized patients
David K Chan1, Thomas H Gallagher, Richard Reznick
1Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.
Background:
Calls are increasing for physicians to disclose harmful medical errors to patients, but little is known about how physicians perform this challenging task. For surgeons, communication about errors is particularly important since surgical errors can have devastating consequences. Our objective was to explore how surgeons disclose medical errors using standardized patients.
Methods:
Thirty academic surgeons participated in the study. Each surgeon discussed 2 of 3 error scenarios (wrong-side lumpectomy, retained surgical sponge, and hyperkalemia-induced arrhythmia) with standardized patients, yielding a total of 60 encounters. Each encounter was scored by using a scale developed to rate 5 communication elements of effective error disclosure. Half of the encounters took place face-to-face; the remainder occurred by videoconference.
Results:
Surgeons were rated highest on their ability to explain the medical facts about the error (mean scores for the 3 scenarios ranged from 3.93 to 4.20; maximum possible score, 5). Surgeons used the word error or mistake in only 57% of disclosure conversations, took responsibility for the error in 65% of encounters, and offered a verbal apology in 47%. Surgeons acknowledged or validated patients' emotions in 55% of scenarios. Eight percent discussed how similar errors would be prevented, and 20% offered a second opinion or transfer of care to another surgeon.
Conclusions:
The patient safety movement calls for disclosure of medical errors, but significant gaps exist between how surgeons disclose errors and patient preferences. Programs should be developed to teach surgeons how to communicate more effectively with patients about errors.
Insights
Physicians struggle to disclose medical errors effectively. Surgeons rarely admit fault or apologize, highlighting a need for better communication training to meet patient safety standards.
Area of Science:
- Medical Communication
- Patient Safety
- Surgical Practice
Background:
- Increasing calls for physicians to disclose medical errors to patients.
- Limited understanding of how physicians, especially surgeons, handle error disclosure.
- Surgical errors carry severe consequences, making communication crucial.
Purpose of the Study:
- To explore how surgeons disclose medical errors.
- Utilized standardized patients to simulate error disclosure scenarios.
- Assessed communication elements in error disclosure.
Main Methods:
- Thirty academic surgeons participated.
- Engaged in 60 simulated error disclosure encounters (face-to-face and videoconference).
- Scored encounters using a 5-element communication scale.
Main Results:
- Surgeons excelled at explaining medical facts (3.93-4.20/5).
- Low rates of admitting error (57%), taking responsibility (65%), and apologizing (47%).
- Limited discussion of prevention (8%) or care transfer (20%).
Conclusions:
- Significant gaps exist between surgeon error disclosure practices and patient expectations.
- Current practices fall short of patient safety goals.
- Need for targeted training programs to improve surgeon communication about errors.
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