Negotiating medical virtues: toward the development of a physician mistake disclosure model

Statistics show that nearly 98,000 patients die each year because of preventable medical mistakes. Despite legal obligations, a majority of physicians either fail to disclose a mistake or disclose it in an incompetent manner, causing detrimental outcomes. This article is the first to synthesize existing research on medical mistakes into an integrative physician mistake disclosure model. The proposed model theorizes that physicians conduct a cost-benefit analysis prior to deciding whether or not to disclose a medical mistake. In the event of disclosure, informational and relational disclosure competence is hypothesized to mediate the inherent detrimental effects of physician defensiveness on immediate and long-term outcomes. The article provides detailed directions for future research and discusses practical implications of the physician mistake disclosure model for physicians and health-care institutions. Most important, the model implies that a supportive organizational climate is needed to curb destructive physician defensiveness, optimize disclosure competence, and minimize detrimental outcomes. Physicians and health-care institutions are advised to collaborate in their attempts to enhance long-term error management and reduce the current number of fatal medical mistakes. The physician mistake disclosure model adds to our current understanding of medical mistake disclosure, and represents a heuristic research and training tool that has the potential to save lives.