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Patient assessments of a hypothetical medical error: effects of health outcome, disclosure, and staff responsiveness
  1. A Cleopas1,,
  2. A Villaveces1,
  3. A Charvet,
  4. P A Bovier2,
  5. V Kolly1,
  6. T V Perneger1,3
  1. 1Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
  2. 2Department of Community Medicine, University Hospitals of Geneva, Geneva, Switzerland
  3. 3Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Switzerland
  1. Correspondence to:
 Dr T V Perneger
 Quality of Care Service, University Hospitals of Geneva, 1211 Geneva 14, Switzerland; thomas.perneger{at}


Objective: To assess whether patients’ perceptions of a hypothetical medical error are influenced by staff responsiveness, disclosure of error, and health consequences of the error.

Design: Hypothetical scenario describing a medication error submitted by mail. Three factors were manipulated at random: rapid v slow staff responsiveness to error; disclosure v non-disclosure of the error; and occurrence of serious v minor health consequences.

Participants: Patients discharged from hospital.

Measures: Assessment of care described in the scenario as bad or very bad, rating of care as unsafe, and intent to not recommend the hospital.

Results: Of 1274 participants who evaluated the scenario, 71.4% rated health care as bad or very bad, 60.2% rated healthcare conditions as unsafe, and 25.5% stated that they would not recommend the hospital. Rating health care as bad or very bad was associated with slow reaction to error (odds ratio (OR) 2.8, 95% CI 2.1 to 3.6), non-disclosure of error (OR 2.0, 95% CI 1.5 to 2.6), and serious health consequences (OR 3.4, 95% CI 2.6 to 4.5). Similar associations were observed for rating healthcare conditions as unsafe and the intent to not recommend the hospital. Younger patients were more sensitive to non-disclosure than older patients.

Conclusions: Former patients view medical errors less favorably when hospital staff react slowly, when the error is not disclosed to the patient, and when the patient suffers serious health consequences.

  • patient perceptions
  • medical error
  • patient safety

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  • Deceased.

  • Funded by the Quality of Care Program of University Hospitals of Geneva. There was no external funding.

  • Competing interests: none.

  • Part of this paper was presented at the 25th Annual Meeting of the Society for Medical Decision Making, Chicago, USA, October 2003.

  • AC and AV contributed equally to this article.

  • Ethics review: As a quality improvement project that entailed minimal risk to participants, the Hospital Research Ethics Committee exempted the survey from full formal review.