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ARTICLE

Health Plan Members' Views about Disclosure of Medical Errors

Kathleen M. Mazor, EdD; Steven R. Simon, MD; Robert A. Yood, MD; Brian C. Martinson, PhD; Margaret J. Gunter, PhD; George W. Reed, PhD; and Jerry H. Gurwitz, MD

16 March 2004 | Volume 140 Issue 6 | Pages 409-418

Background: Various authorities and national organizations encourage disclosing medical errors, but there is little information on how patients respond to disclosure.

Objective: To examine how the type of error, severity of adverse clinical outcome, and level of disclosure affect patients' responses to error and disclosure.

Design: Mail questionnaire survey (8 versions were developed) varying 3 factors in a completely crossed, randomized, factorial design. Each questionnaire included a vignette describing 1) a medical error (failure to check for penicillin allergy or inadequate monitoring of antiepileptic medication); 2) an associated clinical outcome (life-threatening or less serious); and 3) a physician–patient dialogue, with either full disclosure (acceptance of responsibility and an apology) or nondisclosure (expression of regret without acceptance of responsibility or an apology).

Setting: New England–based health plan.

Participants: Random sample of 1500 adult members received the questionnaire, with a 66% response rate.

Measurements: Likelihood of changing physicians, likelihood of seeking legal advice, ratings of patient satisfaction, trust and emotional reaction in response to a vignette and dialogue, and views on medical error and disclosure.

Results: Full disclosure reduced the reported likelihood of changing physicians and increased patient satisfaction, trust, and positive emotional response. Full disclosure reduced the reported likelihood of seeking legal advice in only 1 error-and-outcome vignette. In the other vignettes, the percentage of patients indicating that they would seek legal advice was relatively high even with full disclosure. Almost all respondents (98.8%) wanted to be told of errors, most (83%) favored financial compensation if harm occurred, and few (12.7%) favored compensation if no harm occurred.

Limitations: Since the study was done in the context of a managed care plan in one geographic area, it could not assess whether the results are generalizable to other populations. In addition, it could not determine whether responses to the simulated situations used predict responses to real situations.

Conclusions: Patients will probably respond more favorably to physicians who fully disclose medical errors than to physicians who are less forthright, but the specifics of the case and the severity of the clinical outcome also affect patients' responses. In some circumstances, the desire to seek legal advice may not diminish despite full disclosure.

Editors' Notes Context Disclosing medical errors is ethically appropriate, but its effect on the doctor–patient relationship and the likelihood of patients seeking legal advice is unknown. Contribution Clinical vignettes and questionnaires assessing patient opinion were mailed to members of a health maintenance organization. Each vignette varied the type of error, its severity, and the completeness of error disclosure. Respondents indicated that full disclosure improved trust, satisfaction, and emotional response. Decisions to seek legal advice were complex and were not necessarily deflected by full disclosure. Implications While full disclosure improved patient satisfaction, it did not prevent or increase the likelihood of seeking legal advice. –The Editors

 

Author and Article Information

From the Meyers Primary Care Institute, University of Massachusetts Medical School, and Fallon Foundation, Worcester, Massachusetts; Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; HealthPartners Research Foundation, Minneapolis, Minnesota; and Lovelace Clinic Foundation, Albuquerque, New Mexico.

Acknowledgments: The authors thank Andrew Giese and Ryan Tappin for technical assistance and Maureen Mondor and Patricia O'Mara for their support.

Grant Support: By the HMO Research Network Center for Education and Research on Therapeutics (CERTs) (AHRQ U18HS10391-01), the HMO Research Network CERTs Prescribing Safety Program (AHRQ U18HS11843-01), the National Patient Safety Foundation and the Commonwealth Fund (20030288) (Drs. Mazor and Gurwitz), and a Morgan–Zinsser Fellowship from the Academy at Harvard Medical School (Dr. Simon).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Kathleen M. Mazor, EdD, Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605.

Current Author Addresses: Drs. Mazor, Yood, and Gurwitz: Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605.

Dr. Simon: Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215.

Dr. Martinson: HealthPartners Research Foundation, 8100 34th Avenue South, PO Box 1524, Minneapolis, MN 55440-1524.

Dr. Gunter: Lovelace Clinic Foundation, 2309 Renard Place SE, Suite 103-B, Albuquerque, NM 87106.

Dr. Reed: Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Author Contributions: Conception and design: K.M. Mazor, S.R. Simon, R.A. Yood, B.C. Martinson, M.J. Gunter, G.W. Reed, J.H. Gurwitz.

Analysis and interpretation of the data: K.M. Mazor, S.R. Simon, R.A. Yood, B.C. Martinson, M.J. Gunter, G.W. Reed, J.H. Gurwitz.

Drafting of the article: K.M. Mazor, J.H. Gurwitz.

Critical revision of the article for important intellectual content: K.M. Mazor, S.R. Simon, R.A. Yood, B.C. Martinson, G.W. Reed, J.H. Gurwitz.

Final approval of the article: K.M. Mazor, S.R. Simon, R.A. Yood, B.C. Martinson, M.J. Gunter, G.W. Reed, J.H. Gurwitz.

Provision of study materials or patients: K.M. Mazor.

Statistical expertise: G.W. Reed.

Obtaining of funding: K.M. Mazor.

Collection and assembly of data: K.M. Mazor.

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