Risk managers, physicians, and disclosure of harmful medical errors.
BACKGROUND
Physicians are encouraged to disclose medical errors to patients, which often requires close collaboration between physicians and risk managers.


METHODS
An anonymous national survey of 2,988 healthcare facility-based risk managers was conducted between November 2004 and March 2005, and results were compared with those of a previous survey (conducted between July 2003 and March 2004) of 1,311 medical physicians in Washington and Missouri. Both surveys included an error-disclosure scenario for an obvious and a less obvious error with scripted response options.


RESULTS
More risk managers than physicians were aware that an error-reporting system was present at their hospital (81% versus 39%, p < .001) and believed that mechanisms to inform physicians about errors in their hospital were adequate (51% versus 17%, p < .001). More risk managers than physicians strongly agreed that serious errors should be disclosed to patients (70% versus 49%, p < .001). Across both error scenario, risk managers were more likely than physicians to definitely recommend that the error be disclosed (76% versus 50%, p < .001) and to provide full details about how the error would be prevented in the future (62% versus 51%, p < .001). However, physicians were more likely than risk managers to provide a full apology recognizing the harm caused by the error (39% versus 21%, p < .001).


CONCLUSIONS
Risk managers have more favorable attitudes about disclosing errors to patients compared with physicians but are less supportive of providing a full apology. These differences may create conflicts between risk managers and physicians regarding disclosure. Health care institutions should promote greater collaboration between these two key participants in disclosure conversations.
Loren
David J
DJ
Division of Pediatrics, University of Washington, Seattle, USA. dloren@uw.edu
Garbutt
Jane
J
Dunagan
W Claiborne
WC
Bommarito
Kerry M
KM
Ebers
Alison G
AG
Levinson
Wendy
W
Waterman
Amy D
AD
Fraser
Victoria J
VJ
Summy
Elizabeth A
EA
Gallagher
Thomas H
TH
D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006739:Hospital Administration / Q000941:ethics / Q000639:trends; D006801:Humans; D016365:Liability, Legal / Q000191:economics; D008297:Male; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence; D019300:Medical Errors; D008875:Middle Aged; D016134:Organizational Policy; D010820:Physicians / Q000941:ethics / Q000523:psychology; D012308:Risk Management / Q000941:ethics* / Q000458:organization & administration / Q000639:trends; D014342:Truth Disclosure; D014481:United States