Disclosure of Medical Errors: Physicians’ Knowledge, Attitudes and Practices (KAP) in an Oncology Center

Abstract

Background Between the need for transparency in healthcare, widely promoted by patient’s safety campaigns, and the fear of negative consequences and malpractice threats, physicians face challenging decisions on whether or not disclosing medical errors to patients and families is a valid option. We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center regarding medical error disclosure.Methods This is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made. A day-long training workshop consisting of didactic lectures, short and long case scenarios with role playing and feedback from the instructors, were conducted. Physicians who attended these training workshops were invited to complete the questionnaire at the end of the training, and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments.Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance. Results Eighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). Sixty Five percent of physicians were males and the mean number of years of experience was 16.5 years. Eighty-Seven percent (n=73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan’s Law on Medical and Health Liability (66.7% vs 45.5%, p-value = 0.017) and the Law was more likely to affect their decision on error disclosure (61.8% vs 36.4%, p-value= 0.024).Conclusion Formal training workshops on disclosing medical errors have the power to positively influence physicians’ KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the health care system.

Experience of obstetricians and gynecologists in the management of medicolegal cases in Egypt

“…A wide distribution of the questionnaire and receiving responses from 70% of governorates could compensate for the relatively limited participants' number. Generally, limited participation could be attributed to the tendency for non-disclosure of workrelated data or lack of interest in the research topic which is in agreement with Mansour et al 2020 [20].…”

“…The high participation of middle-aged physicians is attributed to their high accessibility to online pages through which the questionnaire was distributed. More senior doctors were often less skillful in accessing webbased sites than junior staff [20].…”

Quadcare Model for Healthcare Providers

“…Accumulatively, these HCPs face a great deal of fear of disclosing medical errors and conflicts that may arise amongst one another. Such admission carries potential liability for malpractice, a tarnished professional reputation, blame, and embarrassment [32,33]. Following the COVID-19 pandemic, it is estimated that nearly 20% of healthcare workers left the field, 33% of physicians in medical practices retired early or burned out in 2021, and in the most recent survey data released by Elsevier Health, 47% of U.S. clinicians expect to leave their current position, with 39% of these departing from the healthcare profession altogether [34][35][36].…”

Disclosing Adverse Events in Healthcare: Understanding the Gap Between Knowledge and Practice in Developing Countries

“…[2] A medical error disclosure is defined as the communication between a healthcare provider and a patient, family member, or patient's legal representative to admit the occurrence of a medical error, including a clear explanation of what happened and how it relates to health outcomes. [4] Although various professional and ethical guidelines, regulations, and laws recommend and organize medical error disclosure practices and policies, healthcare providers find themselves facing a challenging decision in such situations owing to the need for transparency for patient safety guidelines and the fear of negative impacts, like medicolegal concerns and malpractice claims. [4] Healthcare providers, especially physi-cians, may find difficulty in disclosing medical errors because it requires high level of integrity.…”

“…[4] Although various professional and ethical guidelines, regulations, and laws recommend and organize medical error disclosure practices and policies, healthcare providers find themselves facing a challenging decision in such situations owing to the need for transparency for patient safety guidelines and the fear of negative impacts, like medicolegal concerns and malpractice claims. [4] Healthcare providers, especially physi-cians, may find difficulty in disclosing medical errors because it requires high level of integrity. [5] In the past 2 decades, many initiatives have been implemented, such as the unanticipated outcome policy of the United States Joint Commission on Accreditation of Healthcare Organization, the disclosure standard developed by the Australian Council for Safety and Quality in Health Care, the duty of condor declared by the UK's National Health System, and the call of the Canada's Royal College of Physicians and Surgeons to promote disclosure of safety issues.…”