Doctors are far more willing to be candid with imaginary patients than real ones, University of Iowa researchers have found.
The investigators, who are health-care professionals themselves, surveyed 338 faculty and resident physicians, plus 200 third-year students, at four medical schools. They found that 97% of the doctors would tell a hypothetical patient the wrong drug had been prescribed when the error resulted “minor harm,” such as prolonged treatment or discomfort, and that 93% would admit their mistake, even if it had the “major” consequences of disability or death.
But when it came to putting theory into practice, only 41% of the faculty and residents reported they had disclosed an actual minor error, and just 5% said they had disclosed an actual major mistake. In addition, 19% reported choosing not to disclose a minor incident, and 4% said they did not disclose a major error. “There appears to be a gap between physicians’ attitudes and practices,” the researchers commented.
But the survey also showed a link between experience and openness. For example, faculty respondents were more willing than residents or students to disclose an error that did no harm (80% vs. 65% vs. 50%). They also were less concerned about personal risks, such as loss of reputation (54% vs. 67% vs. 76%), professional discipline (46% vs. 66% vs. 86%), or malpractice litigation (76% vs. 83% vs. 91%).
“This implies that, with experience, physicians become more comfortable with error disclosure,” the study notes. “It suggest that if trainees can observe the practice of error disclosure, the learning environment might accelerate the re-cognition that errors will accompany even the best clinical efforts, and that disclosure of errors is a component of respectful care” (J Gen Intern Med. 2007;22:988-996).