title: Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem.
abstract: BACKGROUND
  The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians.
  
  
  METHODS
  A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency.
  
  
  RESULTS
  The current literature underscores that a complex Web of factors influence physician reluctance to engage in transparency. Specifically, 4 domains of barriers emerged from this analysis: intrapersonal, interpersonal, institutional, and societal.
  
  
  CONCLUSIONS
  Transparency initiatives will require vigorous, interdisciplinary efforts to address the systemic and pervasive nature of the problem. Several ethical and social-psychological barriers suggest that medical schools and hospitals should collaborate to establish continuity in education and ensure that knowledge acquired in early education is transferred into long-term learning. At the institutional level, practical and cultural barriers suggest the creation of supportive learning environments and private discussion forums where physicians can seek moral support in the aftermath of an error. To overcome resistance to culture transformation, incremental change should be considered, for example, replacing arcane transparency policies and complex reporting mechanisms with clear, user-friendly guidelines.
authors.affiliation: From the *America's Essential Hospitals, Washington, DC; †Division Chief, Patient Safety and Clinical Excellence, Patient Safety Officer, Florida Hospital. Celebration, Florida; ‡Armstrong Institute for Patient Safety & Quality, and, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; §University of Central Florida, College of Health and Public Affairs, Department of Social Work; and ∥University of Central Florida, College of Health and Public Affairs, Department of Public Affairs, Orlando, Florida.
authors.forename: Bianca
authors.initials: B
authors.lastname: Perez
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Knych
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver
authors.forename: Aaron
authors.initials: A
authors.lastname: Liberman
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Abel
authors.forename: Dawn
authors.initials: D
authors.lastname: Oetjen
authors.forename: Thomas T H
authors.initials: TT
authors.lastname: Wan
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D030881:Disclosure / Q000941:ethics*; D006801:Humans; D019300:Medical Errors / Q000941:ethics* / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics*; D010820:Physicians / Q000941:ethics; D017009:Professional Autonomy; D012308:Risk Management