Disclosing unavoidable causes of adverse events improves patients' feelings towards doctors

The process of medical mediation involves the reconstruction of doctor-patient relationships through sharing mutual truthful information and encouraging dialogue between doctors and their patients. This study was designed to examine the effects of disclosing the avoidable as well as unavoidable causes of doctors' behavior following malpractice or perceived inconsiderate behavior on patients' feelings in medical mediation. An avoidable cause was defined as doctor's behavior that was incautious or showed insufficient empathy. An unavoidable one, however, was defined as any cause other than doctors' behavior. A questionnaire was administered to 385 Japanese hospital outpatients, in which participants were presented a range of scenarios with the above two causes for doctor's behavior or an adverse event. Participants' feelings toward the doctor in each scenario were measured on a seven-point scale following disclosure of each cause. The five scenarios provoking negative feelings toward doctors involved "(the patient) being ignored," "refusal of a request," "dominating behavior," "a minor incident," and "an adverse event." The valid response rate was 62.9% (242/385). Negative feelings were evoked in all five scenarios. After disclosure of avoidable causes, scores for negative feelings significantly increased between 3% and 33%. In contrast, after disclosure of unavoidable causes, scores for negative feelings significantly decreased between 11% and 43%. These findings imply that disclosure of causal information in medical mediation will provide the opportunity to reevaluate unexpected doctors' behavior and change patients' negative feelings. Therefore, disclosures should be made in the case of not only unavoidable causes but also avoidable ones.