Kaldjian Lauris C, Jones Elizabeth W, Wu Barry J, Forman-Hoffman Valerie L, Levi Benjamin H, Rosenthal Gary E
Division of General Internal Medicine, Department of Internal Medicine, 1-106 MEB, University of Iowa Carver College of Medicine, 500 Newton Road, Iowa City, IA 52242, USA.
J Gen Intern Med. 2007 Jul;22(7):988-96. doi: 10.1007/s11606-007-0227-z. Epub 2007 May 1.
Disclosing errors to patients is an important part of patient care, but the prevalence of disclosure, and factors affecting it, are poorly understood.
To survey physicians and trainees about their practices and attitudes regarding error disclosure to patients.
Survey of faculty physicians, resident physicians, and medical students in Midwest, Mid-Atlantic, and Northeast regions of the United States.
Actual error disclosure; hypothetical error disclosure; attitudes toward disclosure; demographic factors.
Responses were received from 538 participants (response rate = 77%). Almost all faculty and residents responded that they would disclose a hypothetical error resulting in minor (97%) or major (93%) harm to a patient. However, only 41% of faculty and residents had disclosed an actual minor error (resulting in prolonged treatment or discomfort), and only 5% had disclosed an actual major error (resulting in disability or death). Moreover, 19% acknowledged not disclosing an actual minor error and 4% acknowledged not disclosing an actual major error. Experience with malpractice litigation was not associated with less actual or hypothetical error disclosure. Faculty were more likely than residents and students to disclose a hypothetical error and less concerned about possible negative consequences of disclosure. Several attitudes were associated with greater likelihood of hypothetical disclosure, including the belief that disclosure is right even if it comes at a significant personal cost.
There appears to be a gap between physicians' attitudes and practices regarding error disclosure. Willingness to disclose errors was associated with higher training level and a variety of patient-centered attitudes, and it was not lessened by previous exposure to malpractice litigation.
向患者披露医疗差错是患者护理的重要组成部分，但差错披露的发生率及其影响因素尚不清楚。
调查医生和实习医生在向患者披露差错方面的做法和态度。
对美国中西部、大西洋中部和东北部地区的在职医生、住院医生和医学生进行调查。
实际差错披露情况；假设差错披露情况；对披露的态度；人口统计学因素。
共收到538名参与者的回复（回复率=77%）。几乎所有在职医生和住院医生都表示，他们会披露导致患者轻微（97%）或严重（93%）伤害的假设差错。然而，只有41%的在职医生和住院医生披露过实际发生的轻微差错（导致治疗时间延长或不适），只有5%的人披露过实际发生的严重差错（导致残疾或死亡）。此外，19%的人承认未披露实际发生的轻微差错，4%的人承认未披露实际发生的严重差错。医疗事故诉讼经历与较少的实际或假设差错披露无关。在职医生比住院医生和医学生更有可能披露假设差错，且对披露可能产生的负面后果担忧较少。几种态度与更高的假设差错披露可能性相关，包括认为即使披露会带来巨大个人代价也是正确的这一信念。
医生在差错披露的态度和做法之间似乎存在差距。披露差错的意愿与更高的培训水平和多种以患者为中心的态度相关，并且不会因先前经历过医疗事故诉讼而降低。
