Elsevier

Surgery

Volume 138, Issue 5, November 2005, Pages 851-858
Surgery

Original communication
How surgeons disclose medical errors to patients: A study using standardized patients

https://doi.org/10.1016/j.surg.2005.04.015Get rights and content

Background

Calls are increasing for physicians to disclose harmful medical errors to patients, but little is known about how physicians perform this challenging task. For surgeons, communication about errors is particularly important since surgical errors can have devastating consequences. Our objective was to explore how surgeons disclose medical errors using standardized patients.

Methods

Thirty academic surgeons participated in the study. Each surgeon discussed 2 of 3 error scenarios (wrong-side lumpectomy, retained surgical sponge, and hyperkalemia-induced arrhythmia) with standardized patients, yielding a total of 60 encounters. Each encounter was scored by using a scale developed to rate 5 communication elements of effective error disclosure. Half of the encounters took place face-to-face; the remainder occurred by videoconference.

Results

Surgeons were rated highest on their ability to explain the medical facts about the error (mean scores for the 3 scenarios ranged from 3.93 to 4.20; maximum possible score, 5). Surgeons used the word error or mistake in only 57% of disclosure conversations, took responsibility for the error in 65% of encounters, and offered a verbal apology in 47%. Surgeons acknowledged or validated patients' emotions in 55% of scenarios. Eight percent discussed how similar errors would be prevented, and 20% offered a second opinion or transfer of care to another surgeon.

Conclusions

The patient safety movement calls for disclosure of medical errors, but significant gaps exist between how surgeons disclose errors and patient preferences. Programs should be developed to teach surgeons how to communicate more effectively with patients about errors.

Section snippets

Methods

Each of the 30 surgeons was assigned randomly to meet with SPs portraying 2 of the 3 error scenarios described below. Half of the surgeon-SP encounters took place face-to-face, while the remainder occurred by videoconference. In prior work, the investigators found that videoconferenced SPs were a feasible and well-accepted approach for assessing surgeons' communication skills.20 The surgeon read a brief vignette describing the error and then was instructed to discuss what had happened with the

Results

Inter-rater reliabilities of the 5-item aggregate and overall impression scores between SP and physician raters were good to excellent (.58 to .83). Internal consistencies of the rating scale were moderate to high (.42 to .84). Both inter-rater reliabilities and internal consistencies were similar between the 2 media. Differences in the individual item scores, the 5-item aggregate scores, and the overall impression scores were not significant between the face-to-face and videoconferencing

Comment

Surgeons face a difficult dilemma when deciding whether and how to disclose a harmful error to a patient. Our study, the first to assess how surgeons currently disclose harmful errors to patients, suggests that surgeons vary widely in their approach to this difficult task. In many cases, surgeons failed to use recommended error disclosure skills, such as explicitly stating that an error took place, apologizing, and discussing plans for error prevention. These disclosure shortcomings were

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  • Cited by (0)

    Supported by grants from the American Board of Medical Specialties and the Agency for Healthcare Research and Quality (1U18HS1189801, 1K08HS01401201). Dr Gallagher also received support from the Greenwall Foundation Faculty Scholars in Bioethics Program.

    All authors participated in the study design, collection of data, interpretation of results and writing or review of the paper.

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