Patients' physicians' attitudes regarding the disclosure of medical errors
Patients' physicians' attitudes regarding the disclosure of medical errors
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DOI：
10.1001/jama.289.8.1001
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发表时间：
2003-02-26
影响因子：
120.7
通讯作者：
Levinson, W
中科院分区：
文献类型：
--
作者：
Gallagher, TH;Waterman, AD;Levinson, W
尽管卫生保健从业人员尽了最大的努力，医疗事故是不可避免的。向患者披露错误是患者的愿望，也是伦理学家和专业组织的建议，但对于患者和医生认为应该如何讨论医疗错误，人们知之甚少。目的了解患者和医生对差错披露的态度。共组织13个焦点组，其中6组为成人患者，4组为学术和社区医生，3组为医生和患者。共有52名患者和46名医生参与。焦点小组记录定性分析确定患者和医生对医疗差错披露的态度；医生是否披露了患者所希望的信息；以及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。结果差错发生后，患者和医生的需求均未得到满足。患者希望披露所有有害的错误，并寻求有关发生了什么，为什么会发生错误，如何减轻错误的后果，以及如何防止复发的信息。医生们一致认为，应该披露有害的错误，但在告诉患者错误时，“措辞要谨慎”。尽管医生披露了不良事件，但他们往往避免说明发生了错误，错误发生的原因，或如何防止复发。病人还希望在犯错后得到医生的情感支持，包括道歉。然而，医生们担心道歉可能会产生法律责任。当错误发生时，医生也会感到不安，但不知道去哪里寻求情感支持。结论：医生可能没有提供患者在发生有害医疗事故后寻求的信息或情感支持。医生应该努力满足病人对道歉的渴望，以及对错误的性质、原因和预防的了解。机构还应解决涉及医疗差错的从业人员的情感需求。
Context 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.Objective 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.Main Outcome Measures 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.Results 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.Conclusions 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.