Disclosing medical errors to patients: it's not what you say, it's what they hear.
BACKGROUND
There is consensus that patients should be told if they are injured by medical care. However, there is little information on how they react to different methods of disclosure.


OBJECTIVE
To determine if volunteers' reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility.


METHODS
Survey of viewers randomized to watch videos of disclosures of three adverse events (missed mammogram, chemotherapy overdose, delay in surgical therapy) with designed variations in extent of apology (full, non-specific, none) and acceptance of responsibility (full, none).


METHODS
Adult volunteer sample from the general community in Baltimore.


METHODS
Viewer evaluations of physicians in the videos using standardized scales.


RESULTS
Of 200 volunteers, 50% were <40 years, 25% were female, 80% were African American, and 50% had completed high school. For designed variations, scores were non-significantly higher for full apology/responsibility, and lower for no apology/no responsibility. Perceived apology or responsibility was related to significantly higher ratings (chi-square, 81% vs. 38% trusted; 56% vs. 27% would refer, p < 0.05), but inclination to sue was unchanged (43% vs. 47%). In logistic regression analyses adjusting for age, gender, race and education, perceived apology and perceived responsibility were independently related to higher ratings for all measures. Inclination to sue was reduced non-significantly.


CONCLUSIONS
Patients will probably respond more favorably to physicians who apologize and accept responsibility for medical errors than those who do not apologize or give ambiguous responses. Patient perceptions of what is said may be more important than what is actually said. Desire to sue may not be affected despite a full apology and acceptance of responsibility.
Wu
Albert W
AW
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 653, Baltimore, MD 21205, USA. awu@jhsph.edu
Huang
I-Chan
IC
Stokes
Samantha
S
Pronovost
Peter J
PJ
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection / Q000379:methods; D008192:Deception; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D016544:Patient Simulation; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics; D014342:Truth Disclosure / Q000941:ethics; D055815:Young Adult