This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (143)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Medical Ethics  • Patient-Physician Relationship/ Care  • Patient-Physician Communication  • Patient Safety/ Medical Error  • Alert me on articles by topic  Social Bookmarking   What's this?

Thomas H. Gallagher, MD; Amy D. Waterman, PhD; Alison G. Ebers; Victoria J. Fraser, MD; Wendy Levinson, MD

JAMA. 2003;289:1001-1007.

Context  Despite the best efforts of health care practitioners, medical errors are inevitable. Disclosure of errors to patients is desired by patients and recommended by ethicists and professional organizations, but little is known about how patients and physicians think medical errors should be discussed.

Objective  To determine patients' and physicians' attitudes about error disclosure.

Design, Setting, and Participants  Thirteen focus groups were organized, including 6 groups of adult patients, 4 groups of academic and community physicians, and 3 groups of both physicians and patients. A total of 52 patients and 46 physicians participated.

Main Outcome Measures  Qualitative analysis of focus group transcripts to determine the attitudes of patients and physicians about medical error disclosure; whether physicians disclose the information patients desire; and patients' and physicians' emotional needs when an error occurs and whether these needs are met.

Results  Both patients and physicians had unmet needs following errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Physicians agreed that harmful errors should be disclosed but "choose their words carefully" when telling patients about errors. Although physicians disclosed the adverse event, they often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Patients also desired emotional support from physicians following errors, including an apology. However, physicians worried that an apology might create legal liability. Physicians were also upset when errors happen but were unsure where to seek emotional support.

Conclusions  Physicians may not be providing the information or emotional support that patients seek following harmful medical errors. Physicians should strive to meet patients' desires for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors.

Author Affiliations: Departments of Medicine and Medical History and Ethics, University of Washington School of Medicine, Seattle (Dr Gallagher); Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Mo (Drs Gallagher, Waterman, and Fraser and Ms Ebers); and the Department of Medicine, University of Toronto, Toronto, Ontario (Dr Levinson).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Mea Culpa Conundrum
Berlin
Radiology 2009;253:284-287.
FULL TEXT  

Disclosing Harmful Mammography Errors to Patients
Gallagher et al.
Radiology 2009;253:443-452.
ABSTRACT | FULL TEXT  

Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases
Gallagher et al.
Chest 2009;136:897-903.
ABSTRACT | FULL TEXT  

A 62-Year-Old Woman With Skin Cancer Who Experienced Wrong-Site Surgery: Review of Medical Error
Gallagher
JAMA 2009;302:669-677.
ABSTRACT | FULL TEXT  

A New Structure of Attention?: Open Disclosure of Adverse Events to Patients and Their Families
Iedema et al.
Journal of Language and Social Psychology 2009;28:139-157.
ABSTRACT  

Should We Tell the Truth? Why Families in Japan Chose to Tell Their Loved Ones They Were Victims of Iatrogenic HIV Infection
Seki et al.
Qual Health Res 2009;19:723-731.
ABSTRACT  

Medication errors in critical care: risk factors, prevention and disclosure
Camire et al.
CMAJ 2009;180:936-943.
FULL TEXT  

Disclosing Harmful Pathology Errors to Patients
Dintzis and Gallagher
Am J Clin Pathol 2009;131:463-465.
FULL TEXT  

Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research
Curry et al.
Circulation 2009;119:1442-1452.
FULL TEXT  

Narrative Review: Do State Laws Make It Easier to Say "I'm Sorry?"
McDonnell and Guenther
ANN INTERN MED 2008;149:811-815.
ABSTRACT | FULL TEXT  

Patients' and family members' experiences of open disclosure following adverse events
Iedema et al.
Int J Qual Health Care 2008;20:421-432.
ABSTRACT | FULL TEXT  

Medical Error Disclosure Among Pediatricians: Choosing Carefully What We Might Say to Parents
Loren et al.
Arch Pediatr Adolesc Med 2008;162:922-927.
ABSTRACT | FULL TEXT  

Disclosing Medical Errors: We're Halfway There
Levinson
Arch Pediatr Adolesc Med 2008;162:991-992.
FULL TEXT  

Peer support: healthcare professionals supporting each other after adverse medical events
van Pelt
Qual Saf Health Care 2008;17:249-252.
ABSTRACT | FULL TEXT  

Dealing with complaints
Cave and Dacre
BMJ 2008;336:326-328.
FULL TEXT  

Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure
Hobgood et al.
Qual Saf Health Care 2008;17:65-70.
ABSTRACT | FULL TEXT  

Medical errors - a hospital in Nepal searches for answers
Hayes
Trop Doct 2008;38:45-48.
ABSTRACT | FULL TEXT  

Core Competencies in Palliative Care for Surgeons: Interpersonal and Communication Skills
Bradley and Brasel
AM J HOSP PALLIAT CARE 2008;24:499-507.
ABSTRACT  

Unexpected Intraoperative Patient Death: The Imperatives of Family- and Surgeon-Centered Care
Taylor et al.
Arch Surg 2008;143:87-92.
ABSTRACT | FULL TEXT  

Health-Related Safety: A Framework to Address Barriers to Aging in Place
Lau et al.
Gerontologist 2007;47:830-837.
ABSTRACT | FULL TEXT  

Patient Safety in the Pediatric Emergency Care Setting
Committee on Pediatric Emergency Medicine
Pediatrics 2007;120:1367-1375.
ABSTRACT | FULL TEXT  

Guilty, Afraid, and Alone -- Struggling with Medical Error
Delbanco and Bell
NEJM 2007;357:1682-1683.
FULL TEXT  

Disclosing medical errors to patients: a status report in 2007
Levinson and Gallagher
CMAJ 2007;177:265-267.
FULL TEXT  

Disclosing Harmful Medical Errors to Patients
Gallagher et al.
NEJM 2007;356:2713-2719.
FULL TEXT  

The role of communication in paediatric drug safety
Stebbing et al.
Arch. Dis. Child. 2007;92:440-445.
ABSTRACT | FULL TEXT  

Confronting Medical Errors in Oncology and Disclosing Them to Cancer Patients
Surbone et al.
JCO 2007;25:1463-1467.
FULL TEXT  

A Review of Medical Error Reporting System Design Considerations and a Proposed Cross-Level Systems Research Framework
Holden and Karsh
Human Factors: The Journal of the Human Factors and Ergonomics Society 2007;49:257-276.
ABSTRACT  

Rural Community Members' Perceptions of Harm from Medical Mistakes: A High Plains Research Network (HPRN) Study
Van Vorst et al.
J Am Board Fam Med 2007;20:135-143.
ABSTRACT | FULL TEXT  

Reporting and Disclosing Medical Errors: Pediatricians' Attitudes and Behaviors
Garbutt et al.
Arch Pediatr Adolesc Med 2007;161:179-185.
ABSTRACT | FULL TEXT  

Disclosure Of Medical Injury To Patients: An Improbable Risk Management Strategy
Studdert et al.
Health Aff (Millwood) 2007;26:215-226.
ABSTRACT | FULL TEXT  

Mediating Medical Malpractice Lawsuits Against Hospitals: New York City's Pilot Project
Hyman and Schechter
Health Aff (Millwood) 2006;25:1394-1399.
ABSTRACT | FULL TEXT  

Between a Rock and a Hard Place: Disclosing Medical Errors
Crone et al.
Clin. Chem. 2006;52:1809-1814.
ABSTRACT | FULL TEXT  

Choosing Your Words Carefully: How Physicians Would Disclose Harmful Medical Errors to Patients.
Gallagher et al.
Arch Intern Med 2006;166:1585-1593.
ABSTRACT | FULL TEXT  

US and Canadian Physicians' Attitudes and Experiences Regarding Disclosing Errors to Patients.
Gallagher et al.
Arch Intern Med 2006;166:1605-1611.
ABSTRACT | FULL TEXT  

Will Saying "I'm Sorry" Prevent a Malpractice Lawsuit?
Berlin
Am. J. Roentgenol. 2006;187:10-15.
FULL TEXT  

Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness.
Cleopas et al.
Qual Saf Health Care 2006;15:136-141.
ABSTRACT | FULL TEXT  

Prospective assessment of intraoperative precursor events during cardiac surgery.
Wong et al.
Eur. J. Cardiothorac. Surg. 2006;29:447-455.
ABSTRACT | FULL TEXT  

Culture Change at the Source: A Medical School Tackles Patient Safety
Meiris et al.
American Journal of Medical Quality 2006;21:9-12.
 

Patient perspectives of patient-provider communication after adverse events
Duclos et al.
Int J Qual Health Care 2005;17:479-486.
ABSTRACT | FULL TEXT  

Parental Preferences for Error Disclosure, Reporting, and Legal Action After Medical Error in the Care of Their Children
Hobgood et al.
Pediatrics 2005;116:1276-1286.
ABSTRACT | FULL TEXT  

To Err Is Human 5 Years Later
Surbone et al.
JAMA 2005;294:1758-1758.
FULL TEXT  

Disclosing Harmful Medical Errors to Patients: A Time for Professional Action
Gallagher and Levinson
Arch Intern Med 2005;165:1819-1824.
FULL TEXT  

Liability Reform Should Make Patients Safer: "Avoidable Classes of Events" are a Key Improvement
Bovbjerg and Tancredi
J Law Med Ethics 2005;33:478-500.
 

A 38-Year-Old Woman With Fetal Loss and Hysterectomy
Sachs
JAMA 2005;294:833-840.
FULL TEXT  

Should Surgical Errors Always Be Disclosed to the Patient?
Mavroudis et al.
Ann. Thorac. Surg. 2005;80:399-408.
FULL TEXT  

Disclosure of medical error: policies and practice
Kalra et al.
JRSM 2005;98:307-309.
FULL TEXT  

Disclosure of Medical Errors: Ethical Considerations for the Development of a Facility Policy and Organizational Culture Change
Henry
Policy Politics Nursing Practice 2005;6:127-134.
ABSTRACT  

The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of 'golden staph'
Walker and Jacobs
Int J Qual Health Care 2005;17:167-172.
ABSTRACT | FULL TEXT  

Attitudes About Patient Safety: A Survey of Physicians-in-Training
Sorokin et al.
American Journal of Medical Quality 2005;20:70-77.
ABSTRACT  

Communication Skills for Patient-Centered Care. Research-Based, Easily Learned Techniques for Medical Interviews That Benefit Orthopaedic Surgeons and Their Patients
Tongue et al.
JBJS 2005;87:652-658.
FULL TEXT  

Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error
Berlinger and Wu
J. Med. Ethics 2005;31:106-108.
ABSTRACT | FULL TEXT  

Medical Errors
Holder
ASH Education Book 2005;2005:503-506.
ABSTRACT | FULL TEXT  

Communicating With Patients About Medical Errors: A Review of the Literature
Mazor et al.
Arch Intern Med 2004;164:1690-1697.
ABSTRACT | FULL TEXT  

What makes an error unacceptable? A factorial survey on the disclosure of medical errors
Schwappach and Koeck
Int J Qual Health Care 2004;16:317-326.
ABSTRACT | FULL TEXT  

A Mediation Skills Model To Manage Disclosure Of Errors And Adverse Events To Patients
Liebman and Hyman
Health Aff (Millwood) 2004;23:22-32.
ABSTRACT | FULL TEXT  

Radiologist Uncertainty and the Interpretation of Screening
Carney et al.
Med Decis Making 2004;24:255-264.
ABSTRACT  

Health Plan Members' Views about Disclosure of Medical Errors
Mazor et al.
ANN INTERN MED 2004;140:409-418.
ABSTRACT | FULL TEXT  

Open disclosure: the only approach to medical error
Lamb
Qual Saf Health Care 2004;13:3-5.
FULL TEXT  

Other articles noted: 25 Jul 03 to 7 Nov 03
Evid. Based Nurs. 2004;7:e1-1.
FULL TEXT  

Discussion of Medical Errors in Morbidity and Mortality Conferences
Pierluissi et al.
JAMA 2003;290:2838-2842.
ABSTRACT | FULL TEXT  

From the Library
Br J Ophthalmol 2003;87:804-804.
FULL TEXT  

Attitudes on Disclosure of Medical Errors
JWatch Psychiatry 2003;2003:11-11.
FULL TEXT  

Attitudes on Disclosure of Medical Errors
Journal Watch Cardiology 2003;2003:3-3.
FULL TEXT  

Disclosure of Medical Errors
JWatch Pediatrics 2003;2003:3-3.
FULL TEXT  

Attitudes on Disclosure of Medical Errors
JWatch General 2003;2003:1-1.
FULL TEXT  

Minerva
BMJ 2003;326:558-558.
FULL TEXT