Research Institute: Many Patients Don't Want to Know about Medical Errors
The latest addition to the list of “Patient Rights” is the “right” that patients now have to know about any medial error which they may suffer. As with most patient rights, this “right” is not actually a legal right. Instead, it is simply one opinion as to the way that things should be. I will therefore examine the validity of this opinion by examining the reasoning from which it has arisen.
First, it should be said that the right to know about a medical error is not the same as the patient’s right to know the facts about his current condition. According to AMA Ethics Opinion 8.12, “Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions.” This means that a patient who has kidney failure has a right to know that he has kidney failure. With that, there is little debate. But, the issue here is whether the patient also has a right to know that we made an error which caused him to develop kidney failure.
According to some, the patient has a right to know this as well. From what I have read, this right is based on the fact that patients want to know about medical errors. In other words, because patients want to know about medical errors, they have a right to know about medical errors. From both an ethical and a legal perspective, this is nonsense. The mere fact that someone may want to know something does not automatically give them a right to know it.
However, even if we accept this leap of reasoning, and assume that a right can be created out of a want, the fact is that many patients do NOT want to know about medical errors. Hobgood found that 24% of patients do not want to know about a medical error and 33% do not want to know the full extent of an error.
Of course, without asking ahead of time, it is difficult to impossible to discern who these persons are. The dilemma thus becomes one of why we are telling a patient something that cannot help him and that he may not want to know. As a physician, I am perplexed as to why we are being encouraged to force a “right” upon large numbers of patients who do not want it. This type of conduct is not consistent with the principles of medicine, and it does not meet the definition of “patient-centered” care.
(In my own informal survey, I found that 100% of trial lawyers want to know the full extent of any and all medical errors. I believe that this phenomenon explains the basis for this latest “Patient Right.”)
Medical Errors—What and When: What Do Patients Want to Know?
Cherri Hobgood MD 1,*** , Clifford R. Peck MD 1 , Benjamin Gilbert JD, MPH 1,2 , Kathryn Chappell RN, MSN 2 , Bin Zou MPH 1
1 Department of Emergency Medicine, UNC School of Medicine, Chapel Hill, NC 2 Department of Risk Management, UNC Hospitals, Chapel Hill, NC
Objectives: 1) To determine how and when emergency department (ED) patients and their families wish to learn of health care errors. 2) To assess the error threshold this population believes should trigger reporting to government agencies, state medical boards, and hospital patient safety committees. 3) To evaluate the role patients and families believe medical educators should play in this process.
Methods: A 12-item survey was administered to a convenience sample of ED patients and families during evaluation in a tertiary care academic ED. Results were tabulated and data were reported as percentages. Statistical significance was analyzed using the chi-square test.
Results: 258 surveys were returned (80%). A majority of respondents wished to be informed of any medical error (76%) and to have full disclosure of the error's extent (88%). An overwhelming majority of respondents endorse reporting of errors to government agencies (92%), state medical boards (97%), and hospital committees (99%). Most respondents believe medical educators should focus on teaching students to be honest and compassionate (38%) or on how to tell patients about mistakes (25%). The frequency of hospital admission or physician visits per year had no impact on any response pattern (ns with χ2 test).
Conclusions: Regardless of health care utilization, a majority of respondents want full disclosure of medical error and wish to be informed of error immediately upon its detection. Respondents support reporting of errors to government agencies, the state medical board, and hospital committees focused on patient safety. Teaching physicians error disclosure techniques, honesty, and compassion were endorsed as a priority for educators who teach error management.