The many faces of error disclosure: a common set of elements and a definition.
BACKGROUND
Patients want to know when errors happen in their care. Professional associations, ethicists, and patient safety experts endorse disclosure of medical error to patients. Surveys of physicians show that they believe harmful errors should be disclosed to patients, yet errors are often not disclosed.


OBJECTIVE
To understand the discrepancy between patients' expectations and physicians' behavior concerning error disclosure.


METHODS
We conducted focus groups to determine what constitutes disclosure of medical error. Twenty focus groups, 4 at each of 5 academic centers, included 204 hospital administrators, physicians, residents, and nurses.


METHODS
Qualitative analysis of the focus group transcripts with attention to examples of error disclosure by clinicians and hospital administrators.


RESULTS
Clinicians and administrators considered various forms of communication about errors to be error disclosure. Six elements of disclosure identified from focus group transcripts characterized disclosures ranging from Full disclosure (including admission of a mistake, discussion of the error, and a link from the error to harm) to Partial disclosures, which included deferral, misleading statements, and inadequate information to "connect the dots." Descriptions involving nondisclosure of harmful errors were uncommon.


CONCLUSIONS
Error disclosure may mean different things to clinicians than it does to patients. The various forms of communication deemed error disclosure by clinicians may explain the discrepancy between error disclosure beliefs and behaviors. We suggest a definition of error disclosure to inform practical policies and interventions.
Fein
Stephanie P
SP
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA. sfein@mednet.ucla.edu
Hilborne
Lee H
LH
Spiritus
Eugene M
EM
Seymann
Gregory B
GB
Keenan
Craig R
CR
Shojania
Kaveh G
KG
Kagawa-Singer
Marjorie
M
Wenger
Neil S
NS
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D008192:Deception; D026690:Ethics, Clinical; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D010817:Physician-Patient Relations / Q000941:ethics; D014342:Truth Disclosure / Q000941:ethics*