Gallagher Thomas H, Waterman Amy D, Ebers Alison G, Fraser Victoria J, Levinson Wendy
Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Box 356178, Seattle, WA 98195-0001, USA.
JAMA. 2003 Feb 26;289(8):1001-7. doi: 10.1001/jama.289.8.1001.
Despite the best efforts of health care practitioners, medical errors are inevitable. Disclosure of errors to patients is desired by patients and recommended by ethicists and professional organizations, but little is known about how patients and physicians think medical errors should be discussed.
To determine patients' and physicians' attitudes about error disclosure.
DESIGN, SETTING, AND PARTICIPANTS: Thirteen focus groups were organized, including 6 groups of adult patients, 4 groups of academic and community physicians, and 3 groups of both physicians and patients. A total of 52 patients and 46 physicians participated.
Qualitative analysis of focus group transcripts to determine the attitudes of patients and physicians about medical error disclosure; whether physicians disclose the information patients desire; and patients' and physicians' emotional needs when an error occurs and whether these needs are met.
Both patients and physicians had unmet needs following errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error's consequences will be mitigated, and how recurrences will be prevented. Physicians agreed that harmful errors should be disclosed but "choose their words carefully" when telling patients about errors. Although physicians disclosed the adverse event, they often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Patients also desired emotional support from physicians following errors, including an apology. However, physicians worried that an apology might create legal liability. Physicians were also upset when errors happen but were unsure where to seek emotional support.
Physicians may not be providing the information or emotional support that patients seek following harmful medical errors. Physicians should strive to meet patients' desires for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors.
尽管医护人员已尽了最大努力，但医疗差错仍不可避免。向患者披露差错是患者所期望的，也是伦理学家和专业组织所推荐的，但对于患者和医生认为应如何讨论医疗差错，人们了解甚少。
确定患者和医生对差错披露的态度。
设计、地点和参与者：组织了13个焦点小组，包括6组成年患者、4组学术和社区医生，以及3组医生和患者混合组。共有52名患者和46名医生参与。
对焦点小组记录进行定性分析，以确定患者和医生对医疗差错披露的态度；医生是否披露患者想要的信息；差错发生时患者和医生的情感需求以及这些需求是否得到满足。
差错发生后，患者和医生的需求均未得到满足。患者希望披露所有有害差错，并寻求有关发生了什么、差错为何发生、如何减轻差错后果以及如何防止再次发生的信息。医生同意应披露有害差错，但在告知患者差错时“措辞谨慎”。虽然医生披露了不良事件，但他们常常避免提及差错发生、差错为何发生或如何防止再次发生。患者还希望差错发生后能得到医生的情感支持，包括道歉。然而，医生担心道歉可能会带来法律责任。差错发生时医生也会心烦意乱，但不确定从何处寻求情感支持。
医生可能未提供患者在发生有害医疗差错后所寻求的信息或情感支持。医生应努力满足患者对道歉以及对差错性质、原因和预防信息的需求。机构还应关注参与医疗差错的医护人员的情感需求。
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