H. Singh1, R. M. Kauffman2, M. C. Lee3, G. P. Quinn4, L. A. Dossett1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 3Moffitt Cancer Center And Research Institute,Comprehensive Breast Program,Tampa, FL, USA 4Moffitt Cancer Center And Research Institute,Department Of Health Outcomes And Behavior,Tampa, FL, USA
Introduction:
Physicians are ethically obligated to disclose their own medical errors to patients. Physician-level training and risk management systems facilitate proper disclosure. No guidelines, education, training, or systems address the disclosure of medical errors discovered by specialists that have occurred prior to consultation – “pre-referral errors.” We sought to describe attitudes and practices regarding disclosure of pre-referral errors discovered across hospital systems.
Methods:
We conducted face-to-face semi-structured interviews with fellowship-trained cancer specialists at multiple NCI-designated cancer centers. Interviews (30-60 minutes in duration) were audiotaped, transcribed verbatim, and independently coded for a priori and emergent themes using the constant comparative method. Open and axial coding were applied using content analysis.
Results:
Subjects were fellowship-trained specialists of many disciplines (n=30, 40% female, 60% surgeons). The mean age was 46 years; and both the median years of post-graduate training and independent practice were 8. Subjects exhibited a wide range of practice patterns, attitudes/beliefs, and barriers regarding the disclosure of pre-referral errors to their new patients (Table 1). Practice patterns included: no disclosure, vague or limited disclosure, event- or factor-dependent disclosure, and explicit disclosure. Attitudes ranged from no perceived added benefit to disclosing to the thought that the majority of errors are not malicious. A wide range of barriers to disclosing also exist, including: concern for referral base, incomplete information, introducing unnecessary stress for the patient, avoiding a “superior ego” image, and potentially damaging another physician’s reputation and/or livelihood.
Conclusion:
Specialists commonly contend with pre-referral errors but practice patterns, attitudes, beliefs, and barriers vary considerably among specialists. Using these data, there is potential to develop and implement disclosing mechanisms that may help mitigate and overcome identified attitudes, beliefs, and barriers.
