Disclosure of Medical Errors: A Literature Review and the Situation in Turkey

Abstract

Evaluating the efficacy and accuracy of clinical reasoning and distinguishing between complications and medical errors is a difficult task. However, it seems to be an even more difficult task to provide models for systematically reporting and reducing those errors through improvements in the entire web of healthcare delivery. The report “To Err Is Human: Building a Safer Health System” published in 1999 highlighted the importance of patient safety and proposed some interventions. However, a follow up by the authors of the report in 2005 stated that progress in matters of safer care delivery and improved communications was slow. The interventions proposed include “pay for performance” incentives, implementation of electronic health records, diffusion of safe practices and team training for full disclosure of medical errors to patients following injury. As patients increasingly are consumers, customers and regulatory actors in their own healthcare, it becomes harder to hide medical mistakes in clinical encounters. Explaining why and how the medical error happened, giving informed assurance that the mistake will be avoided in the future and offering sincere apologies to patients and families are skills that need to be taught to medical students as early as the undergraduate level. Those skills are very difficult to teach in the university environment and would be learned more effectively with years of experience. However, structured educational programs focusing in the necessity and components of a good medical error disclosure would improve awareness in the importance of an effective and honest doctor–patient relationship. In this review paper, we compare international literature and examples from Turkey with regard to disclosure of medical errors. The Turkish literature on malpractice cases is rich and most of them point out that medical errors occur because of heavy workloads, insufficient infrastructure and lack of high quality medical education. However, the lack of any papers on medical disclosure to patients in Turkey seems to point out to the big communication gap between patients and doctors, among other reasons. We will address some of the reasons for such lack in Turkey and present recommendations about how to disclose medical errors to patients such as implementation of electronic medical error disclosure systems, education and training, and legislation.

Physicians' Disclosure of Medical Error to Patient/Family: The Case of Saudi Arabia

“…Thus, physicians are not willing to disclose errors they have committed however they show some form of remorse by apologizing for incidents that came about as a consequence of the medical error. This is in line with the findings of Yürür et al, who postulate that when physicians do not admit to the occurrence of a medical error they thus fail to provide patients with all information necessary for their future medical decisions and treatments [30]. In regards the relative responders, although most of the responders are highly educated with University, Master and PHD but still their reaction to medical errors mostly with filing a complaint to the administration and judicial complaint which will put extra burden on physician and be barrier to disclose medical error.…”

Factors affecting nursing error communication in intensive care units: A qualitative study

“…Appropriate inter-professional relationships facilitated their error communication, while inappropriate inter-professional relationships could interfere with their error communication. Similarly, former studies showed that nurse-related factors such as professional commitment, accountability, and error management knowledge and experience can facilitate error communication, 40,54 while limited accountability 27,28,40,54 and fear over losing position and respect 40 are barriers to error communication. Honesty is a professional responsibility and hence, errors should not only be disclosed to patients, but also be reported to colleagues in order to help them learn from errors.…”

Comunicación de errores médicos: un caso de simulación para profesionales de la salud hispanohablantes

“…Un elemento clave que respalda la atención centrada en el paciente es la necesidad de honestidad con éste, incluida la necesidad de revelar errores médicos. 2 La primera exposición de muchos médicos a errores ocurre en el entrenamiento. 3,4 En un estudio reciente 79% de los estudiantes de medicina de cuarto año y 98% de los residentes reportaron experiencia con errores médicos.…”

“…Incluso en culturas y países que han aceptado la necesidad de revelar errores médicos, existen barreras y desafíos que incluyen reacciones negativas tanto para el proveedor de atención médica como para el paciente, sentimientos como el miedo a la culpa y el potencial de litigios, la falta de habilidad para revelar errores y la ansiedad. 2,7,8 Para contrarrestar esto, la comunicación de errores médicos ahora se incluye en la educación de residencia en los EUA. 9 La divulgación de errores médicos en América Latina tiene barreras adicionales, ya que existen muy pocas regulaciones para identificar o rastrear errores médicos; 10 sin embargo, cada vez se reconoce más el informe de estos errores.…”