Chan David K, Gallagher Thomas H, Reznick Richard, Levinson Wendy
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.
Surgery. 2005 Nov;138(5):851-8. doi: 10.1016/j.surg.2005.04.015.
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.
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.
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.
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.
要求医生向患者披露有害医疗差错的呼声日益高涨，但对于医生如何完成这项具有挑战性的任务，人们知之甚少。对于外科医生而言，差错沟通尤为重要，因为手术差错可能会带来灾难性后果。我们的目标是探讨外科医生如何通过标准化病人来披露医疗差错。
30名学术外科医生参与了这项研究。每位外科医生与标准化病人讨论了3种差错情景中的2种（错侧乳房切除术、手术海绵遗留、高钾血症诱发心律失常），共产生60次医患交流。每次交流使用一个为有效差错披露的5个沟通要素评分而制定的量表进行评分。一半的交流是面对面进行的；其余的通过视频会议进行。
外科医生在解释差错的医学事实方面得分最高（3种情景的平均得分在3.93至4.20之间；满分5分）。外科医生在仅57%的披露对话中使用了“差错”或“失误”一词，在65%的交流中承担了差错责任，在47%的交流中进行了口头道歉。在55%的情景中，外科医生承认或确认了患者的情绪。8%的交流讨论了如何预防类似差错，20%的交流提供了第二种意见或将护理转给另一位外科医生。
患者安全运动要求披露医疗差错，但外科医生披露差错的方式与患者偏好之间存在显著差距。应制定相关项目，教导外科医生如何更有效地与患者就差错进行沟通。
