A. G. Antunez1, A. Saari1, J. Miller1, R. Jagsi1, J. B. Dimick1, L. A. Dossett1 1University Of Michigan,Ann Arbor, MI, USA
Introduction:
Patients prefer physicians to disclose their self-discovered medical errors, and disclosure expectations and practices have changed accordingly. Patient preferences when physicians discover another provider’s error are unknown. Inter-facility medical error discovery (I-MED) describes scenarios where a medical error is (1) discovered by a provider in a facility different from the one in which it occurred and (2) not known to the responsible provider. Previous work has shown that physicians struggle, and often fail, to fully disclose these errors to patients. This study analyzes patients’ preferences around disclosure in cases of I-MED.
Methods:
We conducted telephone interviews beyond thematic saturation (n=30) from January to March 2018 with patient volunteers in Michigan. Three investigators conducted interviews following a semi-structured guide based on a hypothetical medical error case scenario. Interviews were conducted concurrently with thematic coding, coded independently by two investigators, and discussed until consensus was reached. Analysis proceeded following the inductive and comparative approach of interpretive description.
Results:
Patients considered I-MED functionally equivalent to self-discovered errors, and strongly preferred disclosure in both scenarios. Patients preferred disclosure for a variety of reasons, most commonly describing an inherent value in knowing about their own health, a desire to participate in future care in an informed manner, and a belief that doctors should practice honesty and transparency. The only exceptions to this preference for disclosure were instances of small errors with no impact on patients’ well-being. Patients reported that their trust in the discovering physician would be dramatically reduced if they later found that physician had concealed the responsible physician’s error, rather than disclosing it. Patients said they would likely take certain actions after disclosure of another physician’s error, ranging from confronting the responsible physician to changing providers to pursuing legal action, with the latter being only in cases of debilitating, irreversible errors. All of these findings were mediated by circumstance, with subjects often being empathetic to physicians’ justifications for hesitating to disclose others’ errors, while still emphasizing that they prioritize error disclosure (Table 1).
Conclusion:
This study explores a new domain within the field of error disclosure, concluding that patients almost always preferred disclosure of errors in cases of I-MED. Physicians’ concerns that patients may be distressed or pursue legal action following disclosure are not unfounded. Notably, as long as errors are disclosed transparently and are not especially egregious, patients expressed an emphasis on future care, not on punitive measures. Overall, these findings provide a convincing impetus to devise systems-level solutions to enable I-MED disclosure, possibly via increased medico-legal partnerships and novel channels to address inter-facility errors.
