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Published on: March 29, 2019
Disclosing medical errors to patients: it's not what you say, it's what they hear
Albert W Wu1, I-Chan Huang, Samantha Stokes
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 653, Baltimore, MD 21205, USA. awu@jhsph.edu
Background:
There is consensus that patients should be told if they are injured by medical care. However, there is little information on how they react to different methods of disclosure.
Objective:
To determine if volunteers' reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility.
Design:
Survey of viewers randomized to watch videos of disclosures of three adverse events (missed mammogram, chemotherapy overdose, delay in surgical therapy) with designed variations in extent of apology (full, non-specific, none) and acceptance of responsibility (full, none).
Participants:
Adult volunteer sample from the general community in Baltimore.
Measurements:
Viewer evaluations of physicians in the videos using standardized scales.
Results:
Of 200 volunteers, 50% were <40 years, 25% were female, 80% were African American, and 50% had completed high school. For designed variations, scores were non-significantly higher for full apology/responsibility, and lower for no apology/no responsibility. Perceived apology or responsibility was related to significantly higher ratings (chi-square, 81% vs. 38% trusted; 56% vs. 27% would refer, p < 0.05), but inclination to sue was unchanged (43% vs. 47%). In logistic regression analyses adjusting for age, gender, race and education, perceived apology and perceived responsibility were independently related to higher ratings for all measures. Inclination to sue was reduced non-significantly.
Conclusions:
Patients will probably respond more favorably to physicians who apologize and accept responsibility for medical errors than those who do not apologize or give ambiguous responses. Patient perceptions of what is said may be more important than what is actually said. Desire to sue may not be affected despite a full apology and acceptance of responsibility.
Insights
Physicians who apologize and accept responsibility for medical errors lead to more favorable patient reactions. Patient perception of the disclosure is key, though it may not reduce the desire to sue.
Area of Science:
- Medical disclosure and patient communication
- Patient safety and adverse event reporting
- Physician-patient relationship dynamics
Background:
- Consensus exists on informing patients about medical injuries.
- Limited data available on patient responses to various disclosure methods.
- Understanding patient reactions to physician communication during adverse events is crucial.
Purpose of the Study:
- To assess volunteer reactions to physicians disclosing adverse medical events.
- To determine the impact of apology and acceptance of responsibility on patient perception.
- Investigating how variations in disclosure language affect patient trust and future actions.
Main Methods:
- Survey study involving adult volunteers from the general community.
- Participants viewed videos of simulated adverse event disclosures with varied apologies and responsibility acceptance.
- Standardized scales were used to evaluate viewer perceptions of physician communication.
Main Results:
- Full apologies and acceptance of responsibility correlated with higher positive ratings, though not always statistically significant.
- Perceived apology and responsibility independently predicted significantly higher trust and referral likelihood.
- The inclination to sue was not significantly affected by the disclosure method.
Conclusions:
- Patients tend to react more favorably to physicians who apologize and accept responsibility for errors.
- The patient's perception of the physician's words is more influential than the exact wording.
- Full apologies and responsibility acceptance may not decrease the likelihood of litigation.
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