Article Text

Association of open communication and the emotional and behavioural impact of medical error on patients and families: state-wide cross-sectional survey
  1. Julia C Prentice1,
  2. Sigall K Bell2,3,
  3. Eric J Thomas4,
  4. Eric C Schneider5,
  5. Saul N Weingart6,
  6. Joel S Weissman7,
  7. Mark J Schlesinger8
  1. 1 Betsy Lehman Center for Patient Safety, Boston, Massachusetts, USA
  2. 2 Patient Safety and Quality Initiatives, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3 Harvard Medical School, Boston, Massachusetts, USA
  4. 4 UTHealth-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Health Science Center at Houston, Houston, Texas, USA
  5. 5 The Commonwealth Fund, New York, New York, USA
  6. 6 Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
  7. 7 Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
  8. 8 Health Policy and Management, School of Public Health, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Dr Julia C Prentice, Research and Analysis, Betsy Lehman Center for Patient Safety, Boston, MA 02116, USA; Julia.Prentice{at}


Background How openly healthcare providers communicate after a medical error may influence long-term impacts. We sought to understand whether greater open communication is associated with fewer persisting emotional impacts, healthcare avoidance and loss of trust.

Methods Cross-sectional 2018 recontact survey assessing experience with medical error in a 2017 random digit dial survey of Massachusetts residents. Two hundred and fifty-three respondents self-reported medical error. Respondents were similar to non-respondents in sociodemographics confirming minimal response bias. Time since error was categorised as <1, 1–2 or 3–6 years before interview. Open communication was measured with six questions assessing different communication elements. Persistent impacts included emotional (eg, sadness, anger), healthcare avoidance (specific providers or all medical care) and loss of trust in healthcare. Logistic regressions examined the association between open communication and long-term impacts.

Results Of respondents self-reporting a medical error 3–6 years ago, 51% reported at least one current emotional impact; 57% reported avoiding doctor/facilities involved in error; 67% reported loss of trust. Open communication varied: 34% reported no communication and 24% reported ≥5 elements. Controlling for error severity, respondents reporting the most open communication had significantly lower odds of persisting sadness (OR=0.17, 95% CI 0.05 to 0.60, p=0.006), depression (OR=0.16, 95% CI 0.03 to 0.77, p=0.022) or feeling abandoned/betrayed (OR=0.10, 95% CI 0.02 to 0.48, p=0.004) compared with respondents reporting no communication. Open communication significantly predicted less doctor/facility avoidance, but was not associated with medical care avoidance or healthcare trust.

Conclusions Negative emotional impacts from medical error can persist for years. Open communication is associated with reduced emotional impacts and decreased avoidance of doctors/facilities involved in the error. Communication and resolution programmes could facilitate transparent conversations and reduce some of the negative impacts of medical error.

  • communication
  • medical error, measurement/epidemiology
  • patient safety
  • surveys
  • healthcare quality improvement

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  • Correction notice The article has been corrected since it was published online first. The acknowledgements section has been added in the paper.

  • Contributors All authors except JCP participated in the original design of the recontact survey including providing technical expertise regarding medical errors. All authors participated in the design of the study. JCP analysed the data. JCP and MS had access to the data and drafted the manuscript. All other authors provided critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Solutions IRB approved both surveys.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Please contact the corresponding author to discuss the feasibility of obtaining access to a deidentified data set.

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