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Pathologists' Perspectives on Disclosing Harmful Pathology Error
Suzanne M Dintzis, Emily K Clennon, Carolyn D Prouty
1From the Departments of Pathology (Dr Dintzis), Medicine (Ms Clennon and Drs Prouty, Reich, Elmore, and Gallagher), and Epidemiology (Dr Elmore), University of Washington, Seattle.
Context:
- Medical errors are unfortunately common. The US Institute of Medicine proposed guidelines for mitigating and disclosing errors. Implementing these recommendations in pathology will require a better understanding of how errors occur in pathology, the relationship between pathologists and treating clinicians in reducing error, and pathologists' experiences with and attitudes toward disclosure of medical error.
Objective:
- To understand pathologists' attitudes toward disclosing pathology error to treating clinicians and patients.
Design:
- We conducted 5 structured focus groups in Washington State and Missouri with 45 pathologists in academic and community practice. Participants were questioned about pathology errors, how clinicians respond to pathology errors, and what roles pathologists should play in error disclosure to patients.
Results:
- These pathologists believe that neither treating physicians nor patients understand the subtleties and limitations of pathologic diagnoses, which complicates discussions about pathology errors. Pathologists' lack of confidence in communication skills and fear of being misrepresented or misunderstood are major barriers to their participation in disclosure discussions. Pathologists see potential for their future involvement in disclosing error to patients, but at present advocate reliance on treating clinicians to disclose pathology errors to patients. Most group members believed that going forward pathologists should offer to participate more actively in error disclosure to patients.
Conclusions:
- Pathologists lack confidence in error disclosure communication skills with both treating physicians and patients. Improved communication between pathologists and treating physicians could enhance transparency and promote disclosure of pathology errors. Consensus guidelines for best practices in pathology error disclosure may be useful.
Insights
Pathologists often hesitate to disclose errors due to communication concerns and lack of understanding from clinicians and patients. They prefer clinicians disclose errors but see potential for future involvement.
Area of Science:
- Medical error analysis
- Pathology diagnostics
- Healthcare communication
Background:
- Medical errors are prevalent, necessitating strategies for mitigation and disclosure.
- Pathology error management requires understanding error occurrence, clinician-pathologist collaboration, and disclosure attitudes.
Purpose of the Study:
- To investigate pathologists' perspectives on disclosing pathology errors to clinicians and patients.
Main Methods:
- Five structured focus groups were conducted with 45 pathologists in academic and community settings.
- Discussions covered pathology errors, clinician responses, and pathologists' roles in patient disclosure.
Main Results:
- Pathologists perceive a lack of understanding regarding diagnostic subtleties from clinicians and patients.
- Barriers to disclosure include communication skill deficits and fear of misrepresentation.
- Pathologists currently favor clinician-led disclosure but acknowledge potential for greater future involvement.
Conclusions:
- Pathologists report low confidence in communicating errors to physicians and patients.
- Enhanced communication between pathologists and clinicians can improve transparency and error disclosure.
- Developing consensus guidelines for pathology error disclosure is recommended.