title: Disclosure of medical errors: what factors influence how patients respond?
abstract: BACKGROUND
  Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited.
  
  
  OBJECTIVE
  This study sought to determine whether full disclosure, an existing positive physician-patient relationship, an offer to waive associated costs, and the severity of the clinical outcome influenced patients' responses to medical errors.
  
  
  METHODS
  Four hundred and seven health plan members participated in a randomized experiment in which they viewed video depictions of medical error and disclosure.
  
  
  METHODS
  Subjects were randomly assigned to experimental condition. Conditions varied in type of medication error, level of disclosure, reference to a prior positive physician-patient relationship, an offer to waive costs, and clinical outcome.
  
  
  METHODS
  Self-reported likelihood of changing physicians and of seeking legal advice; satisfaction, trust, and emotional response.
  
  
  RESULTS
  Nondisclosure increased the likelihood of changing physicians, and reduced satisfaction and trust in both error conditions. Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition, but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition. Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact.
  
  
  CONCLUSIONS
  This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors. The clinical outcome also influences patients' responses. The impact of an existing positive physician-patient relationship, or of waiving costs associated with the error remains uncertain.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA 01605, USA. kathleen.mazor@umassmed.edu
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.forename: George W
authors.initials: GW
authors.lastname: Reed
authors.forename: Robert A
authors.initials: RA
authors.lastname: Yood
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Joann
authors.initials: J
authors.lastname: Baril
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
mesh_terms: D001294:Attitude to Health; D006279:Health Maintenance Organizations; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence; D008404:Massachusetts; D019300:Medical Errors; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D014342:Truth Disclosure; D014741:Video Recording