Disclosure of Medical Errors: What Factors Influence How Patients Respond?

Authors

  • Kathleen M. Mazor EdD,

    1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA, USA
    2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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  • George W. Reed PhD,

    1. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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  • Robert A. Yood MD,

    1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA, USA
    2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
    3. Fallon Clinic, Worcester, MA, USA.
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  • Melissa A. Fischer MD, MA Ed,

    1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA, USA
    2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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  • Joann Baril BS,

    1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA, USA
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  • Jerry H. Gurwitz MD

    1. Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation and Fallon Community Health Plan, Worcester, MA, USA
    2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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  • None of the authors have any conflicts of interest to declare.Prior Presentation of Results: Portions of this study were presented in a poster at the National Patient Safety Foundation Congress, Boston, May 4–7, 2004 and at the National Patient Safety Foundation Congress, Orlando, May 4–6, 2005.

Address correspondence and requests for reprints to Dr. Mazor: Meyers Primary Care Institute, University of Massachusetts Medical School and Fallon Foundation, 630 Plantation St, Worcester, MA 01605 (e-mail: kathleen.mazor@umassmed.edu).

Abstract

BACKGROUND: Disclosure of medical errors is encouraged, but research on how patients respond to specific practices is limited.

OBJECTIVE: 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.

PARTICIPANTS: Four hundred and seven health plan members participated in a randomized experiment in which they viewed video depictions of medical error and disclosure.

DESIGN: 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.

MEASURES: Self-reported likelihood of changing physicians and of seeking legal advice; satisfaction, trust, and emotional response.

RESULTS: 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.

CONCLUSIONS: 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.

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