J. S. Lee1, 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 encouraged to disclose their own medical errors and confidential institutional processes facilitate peer review, but no mechanisms exist for providing physician-to-physician feedback when errors are discovered across institutions or health systems. We sought to describe attitudes and practices regarding feedback for medical errors preceding consultation – “pre-referral errors” – that were subsequently discovered by cancer specialists.
Methods:
We conducted face-to-face interviews with cancer specialists at multiple NCI-designated comprehensive cancer centers using a semi-structured interview guide. Interviews 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:
All participants were fellowship-trained cancer specialists of various disciplines (n = 30, 40% female, 60% surgeons). The median years of post-graduate training was 8 (range 6-10); median years of independent practice was 9 (range 2-35). Specialists described varying practices, attitudes, and barriers regarding physician-to-physician feedback for pre-referral errors (Table 1). Practices ranged from providing no feedback to emphasizing feedback with a focus on constructive criticism. Event-related thresholds for providing feedback varied, and participants described difficulty providing feedback across specialties. Common barriers to providing feedback included avoiding a superiority image, concern for referral patterns, lack of time, difficulty reaching referring physicians, and the lack of an established system or guidelines.
Conclusion:
All interviewed cancer specialists encountered pre-referral errors, but attitudes regarding physician-to-physician feedback varied, and consensus on practices for feedback or peer review across institutions is lacking.
