Enhancing the Disclosure of Medical Errors to Patients

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DESCRIPTION (provided by the applicant): Despite our best efforts, medical errors are inevitable. When an error happens, a key question is whether and how the error should be disclosed to the patient. While disclosure is desired by patients, respects ethical principles, and is required by accreditation standards, error disclosure may be uncommon. Preliminary work suggests that one key barrier to error disclosure may be patients' and physicians' fundamentally different perspectives on how disclosure should occur. Current institutional policies may further discourage full error disclosure. Effective error disclosure could enhance patient safety, increase patient trust and satisfaction, and reduce lawsuits. The candidate proposes a series of projects to improve medical error disclosure with the following specific aims: 1) to describe the attitudes of physicians towards error disclosure and determine whether these attitudes are related to personal characteristics (e.g., demographics, specialty, time in practice) and whether they are consistent with intentions for disclosing medical errors; 2) to describe the attitudes of patients towards error disclosure and determine whether these attitudes are related to personal characteristics (e.g., socio-demographics, past experiences, perceptions of medical care) and how they relate to important outcomes such as trust, satisfaction, and intent to change providers or to sue; 3) to assess whether current institutional policies support full disclosure of medical errors; and 4) to develop and disseminate a model institutional error disclosure policy and assess the policy's impact on health care providers' attitudes towards and experience with error disclosure. Specific Aims 1 and 2 will be accomplished through mailed surveys of 2,000 doctors and 2,000 patients. For Specific Aim 3, the candidate will analyze a representative sample of 200 institutional error disclosure policies. Specific Aim 4 involves creating and disseminating a model error disclosure policy at three Seattle academic and community medical centers. The policy's impact will be determined by surveying 300 health care workers before and after the policy's implementation. The project will be led by the candidate who is a physician with a background in bioethics and doctor-patient communication. His career development will be guided by Stephan D. Fihn, M.D., M.P.H., along with a panel of co-mentors with expertise in patient safety, doctor-patient communication, and bioethics: David Bates, M.D.; Wendy Levinson, M.D.; Eric Larson, M.D.; and Bernard Lo, M.D. The career development plan includes coursework in survey design, qualitative research methods, and medical malpractice as well as the guided reading of key texts. The project will take place at the University of Washington, a leading institution in health services research.