Mazor Kathleen M, Reed George W, Yood Robert A, Fischer Melissa A, Baril Joann, Gurwitz Jerry H
Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA 01605, USA.
J Gen Intern Med. 2006 Jul;21(7):704-10. doi: 10.1111/j.1525-1497.2006.00465.x.
Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited.
This study sought to determine whether full disclosure, an existing positive physician-patient relationship, an offer to waive associated costs, and the severity of the clinical outcome influenced patients' responses to medical errors.
Four hundred and seven health plan members participated in a randomized experiment in which they viewed video depictions of medical error and disclosure.
Subjects were randomly assigned to experimental condition. Conditions varied in type of medication error, level of disclosure, reference to a prior positive physician-patient relationship, an offer to waive costs, and clinical outcome.
Self-reported likelihood of changing physicians and of seeking legal advice; satisfaction, trust, and emotional response.
Nondisclosure increased the likelihood of changing physicians, and reduced satisfaction and trust in both error conditions. Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition, but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition. Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact.
This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors. The clinical outcome also influences patients' responses. The impact of an existing positive physician-patient relationship, or of waiving costs associated with the error remains uncertain.
鼓励披露医疗差错，但关于患者对特定做法如何反应的研究有限。
本研究旨在确定全面披露、现有的积极医患关系、免除相关费用的提议以及临床结果的严重程度是否会影响患者对医疗差错的反应。
407名健康计划成员参与了一项随机实验，他们观看了医疗差错及披露情况的视频描述。
受试者被随机分配到实验条件组。条件在用药差错类型、披露程度、提及先前的积极医患关系、免除费用提议以及临床结果方面有所不同。
自我报告的更换医生和寻求法律建议的可能性；满意度、信任度和情绪反应。
不披露增加了更换医生的可能性，并降低了在两种差错情况下的满意度和信任度。不披露增加了寻求法律建议的可能性，并且在漏诊过敏差错情况下与更负面的情绪反应相关，但在监测差错情况下对寻求法律建议或情绪反应没有统计学上的显著影响。积极关系的存在或免除费用的提议均未产生统计学上的显著影响。
本研究提供的证据表明，全面披露可能对患者对医疗差错的反应产生积极影响或没有影响。临床结果也会影响患者的反应。现有的积极医患关系或免除与差错相关费用的影响仍不确定。
