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When Is Hiding Medical Errors OK?

Posted by Marty Hudson on Jan 18, 2011 9:32:14 AM

Interesting article I read this past week on Medscape from WebMD titled “'Some Worms Are Best Left in the Can' -- Should You Hide Medical Errors?”  They posed four questions in Medscape’s ethics survey related to this topic. 

Now I know everyone is different.  Me, I want to know the truth, bottom-line.  Good or bad, don’t hide stuff from me, and never tell me something that is not true.  There is nothing that will make me lose confidence, trust and loyalty faster.  However, there are people that are not that way.  Bad news just causes them to worry, so they would rather not know.  Here are each of the questions with some excerpts.

"Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?" 60.1% of respondents answered "no," and the remaining respondents were almost evenly divided between "yes" (19%) and "it depends" (20.9%).  In the “No” camp one quote was “…because it's difficult to know ahead of time how much a reasonable patient would want to know, erring on the side of disclosure makes the most sense."  Among the comments on the "yes"' side; “If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes.” “I see no benefit in revealing mistakes of no consequence, like giving a patient Tylenol 650 mg instead of 325 mg.”  “Why shake the patient's trust in the doctor for something that is irrelevant?”

"Are there times when it is acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?"  A whopping 94.9% answered in the negative, 1.6% said "yes," and 3.5% said "it depends."  The “No” replies included; "Patients have the right to know what went wrong, as well as what went correct in their treatment."  "Painful and awkward to be sure, but nothing compared to the potential blowback."  "Once you break the rule of truth, you as a physician might as well quit."  "Once a mistake is discovered it must be revealed, root cause analysis performed, and patient informed of the mistake, its consequences if any, and plans to prevent a recurrence."  One hedged their bet, "I would contact an attorney first."  The "it depends" group included a physician who wrote, "If revealing the mistake won't change the management and has not yet caused any harm, I think a 'wait and see' approach is okay." Another would hold back "only if revealing the mistake would cause more harm to the patient, i.e., make him stop all needed treatment."

“Would doctors discuss patient information in situations that did not fully protect patient privacy, ie, socially or in conversation with doctors unrelated to the patient's care?”  More than three-quarters of respondents -- 77% -- said "no," 8.4% said "yes," and 14.2% found an "it depends" middle ground.  The majority of respondents defended informal conversations about patients with other physicians -- which one respondent characterized as "critical to ensuring optimal healthcare" and another called "the best ongoing CME we have -- as long as privacy is upheld." Maintaining anonymity, of course, is easier in big cities than in small towns. Some respondents who insisted that they would never use a name said they did mention age, race, gender, and clinical situation, and as one doctor indicated, "In a smaller community, sometimes details make [identity] apparent."  Two respondents confessed that they yielded to the temptation to name names when they treated movie stars.  Two doctors who had a different view pointed out, "Physicians tell physicians funny stories about patients every day. Usually names are not important," and "This kind of connecting with others and defusing workday tensions keeps us alive and functioning and -- to some extent -- prevents burnout."  Nice to know you may be the butt of a joke with your own health at stake.

"Is it ever acceptable to break patient confidentiality if you know that a patient's health condition may be harming others (ie, a patient with HIV or sexually transmitted disease who does not inform their spouse or partner)?"  Only slightly more than half of the respondents, 53.3%, answered "yes" to this question.  Some 20.1% said "no," and the remaining 26.7% said "it depends."  "Yes" respondents mentioned the physician's "duty to warn," and noted that "One's freedom of confidentiality only goes as far as someone else's rights." Another expressed the view that "Confidentiality is an administrative rule, whereas [avoiding] the likelihood of harm is more of a moral rule and ought to supersede." A doctor who preferred a deliberative approach answered, "I would discuss the situation with the patient, the hospital ethics committee, and a lawyer. If it is permitted under the law, I would not hesitate to help an innocent partner in danger."  Among the "it depends"; "Physicians don't have a duty to people they don't have a doctor-patient relationship with. Our duty is to the patient, and we are not expected to seek out the patient's sexual partners. However, knowing that a patient is HIV positive and that he hasn't informed his significant other of that fact changes the level of duty on the part of the provider."

Here is the entire article if you would like to take a look; http://bit.ly/hUCqXg

Growing up I was told ‘doing the right thing is never easy, but it’s always right’.  For me the ‘right’ answers to these questions fall into the ‘not easy’ category.  Not everyone agrees.  What do you think; When Is Hiding Medical Errors OK?

--- Marty Hudson

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