Perez Bianca, Knych Stephen A, Weaver Sallie J, Liberman Aaron, Abel Eileen M, Oetjen Dawn, Wan Thomas T H
From the *America's Essential Hospitals, Washington, DC; †Division Chief, Patient Safety and Clinical Excellence, Patient Safety Officer, Florida Hospital. Celebration, Florida; ‡Armstrong Institute for Patient Safety & Quality, and, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; §University of Central Florida, College of Health and Public Affairs, Department of Social Work; and ∥University of Central Florida, College of Health and Public Affairs, Department of Public Affairs, Orlando, Florida.
J Patient Saf. 2014 Mar;10(1):45-51. doi: 10.1097/PTS.0b013e31829e4b68.
The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians.
A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency.
The current literature underscores that a complex Web of factors influence physician reluctance to engage in transparency. Specifically, 4 domains of barriers emerged from this analysis: intrapersonal, interpersonal, institutional, and societal.
Transparency initiatives will require vigorous, interdisciplinary efforts to address the systemic and pervasive nature of the problem. Several ethical and social-psychological barriers suggest that medical schools and hospitals should collaborate to establish continuity in education and ensure that knowledge acquired in early education is transferred into long-term learning. At the institutional level, practical and cultural barriers suggest the creation of supportive learning environments and private discussion forums where physicians can seek moral support in the aftermath of an error. To overcome resistance to culture transformation, incremental change should be considered, for example, replacing arcane transparency policies and complex reporting mechanisms with clear, user-friendly guidelines.
医疗差错和医疗事故问题引发了人们对建立医疗保健透明度的浓厚兴趣，换句话说，就是要确保医疗专业人员正式报告医疗差错，并向患者及其家属披露相关结果。然而，研究充分表明，透明度并非医生中的普遍做法。
使用“透明度”“患者安全”“披露”“医疗差错”“差错报告”“医疗事故”“医患关系”和“医生”等检索词对文献进行综述，以查找描述医生透明度障碍的文章。
当前文献强调，一系列复杂因素影响着医生不愿保持透明度的态度。具体而言，该分析得出了4个障碍领域：个人层面、人际层面、机构层面和社会层面。
透明度倡议需要各方积极开展跨学科努力，以应对该问题的系统性和普遍性。一些伦理和社会心理障碍表明，医学院校和医院应合作，确保教育的连贯性，并保证早期教育中获得的知识能转化为长期学习成果。在机构层面，实际和文化障碍表明需要营造支持性的学习环境和私人讨论论坛，让医生在出现差错后能获得道德支持。为克服对文化变革的抵触情绪，应考虑渐进式变革，例如，用清晰、便于使用的指南取代晦涩难懂的透明度政策和复杂的报告机制。
