On higher ground: ethical reasoning and its relationship with error disclosure

Area of Science:

• Medical Ethics
• Patient Safety
• Physician Training

Background:

• Disclosure of medical errors is crucial for patient safety and is an ethical imperative.
• Empirical evidence linking physicians' ethical reasoning to their willingness to disclose errors is lacking.

Purpose of the Study:

• To investigate the association between ethical reasoning scores and the willingness of physicians-in-training to disclose medical errors.
• To determine if higher ethical reasoning correlates with increased disclosure of adverse events.

Main Methods:

• A cross-sectional survey was administered to internal medicine residents at Johns Hopkins Hospital.
• Ethical reasoning was assessed using the Defining Issues Test, Version 2 (DIT-2).
• Residents' responses to a medical error scenario with varying disclosure options were analyzed in relation to DIT-2 scores.

Main Results:

• Residents with higher DIT-2 scores were significantly more likely to explicitly inform patients about an error (41% of residents).
• Higher ethical reasoning scores correlated with providing more detailed explanations of the error (62% of residents).
• Physicians demonstrating more sophisticated ethical reasoning were more inclined to take personal responsibility for the error (71% of residents).

Conclusions:

• Ethical reasoning ability is positively associated with acknowledging errors, offering detailed explanations, and accepting personal responsibility.
• While the low response rate necessitates caution, findings suggest ethical training may enhance medical error disclosure.
• This study highlights a potential pathway to improve patient safety through targeted ethical education for healthcare professionals.