About two years ago, I accidentally gave a Depo-Provera shot to a teenager with sickle cell disease.  When I shared this piece of information with a friend, an emergency room nurse, she said, "Hmm" and thought for a moment.  "That's dangerous because of clotting issues, right?"  In truth, the mistake was not catastrophic, clinically speaking.  Rather, the sharp twinge evoked by the memory stemmed from the unavoidable fact that I had injected one patient's medication into another's arm.  I was near tears when I explained my error to the patient.  She'd simply laughed.  In commiseration, my nurse friend contributed her own gold medal moment of medical mistake-making.  She also decided, after reporting the error to her superior, to tell her patient the truth. 

The impulse to confess, in both of our cases, probably reflected our rapports with our respective patients and the relatively minor natures of our errors.  But it turns out that admitting to making an honest mistake may, in ethical and financial terms, be the most appropriate course of action in almost all situations involving medical error. 

According to a recent New York Times article, responding to errors directly, openly, and with the offer of fair compensation lowers overall numbers of lawsuits and improves patient-provider relationships.  While we may have learned this approach in kindergarten, we lost the message somewhere along the rocky road to outrageous malpractice payouts and the subsequent evolution of a fear-based culture of medicine. It now appears that that culture may be changing. 

Doctors, lawmakers, and insurance companies are taking note.  Health systems at Harvard, Johns Hopkins, Stanford, University of Michigan, and University of Illinois are now promoting full disclosure policies.  In his New York Times article, Kevin Sack writes that institutions which opt for disclosure instead of the standard "deny and defend" tactics, "hope to restore integrity to dealings with patients, [making] it easier to learn from mistakes and dilute anger that often fuels lawsuits."

The statistics are convincing. At the University of Michigan Health System, for example, the number of both claims and lawsuits dropped by two-thirds in the six years which followed the adoption of full disclosure practices.  At the University of Illinois, the number of lawsuits filed was halved within two years of joining the full disclosure bandwagon.  These facilities also train staff and students in the proper protocol for patient disclosure.

There is another benefit to transparency in the face of adverse events.  If doctors, and the hospitals that employ them, must maintain a veneer of infallibility, then all mistakes must be kept protected behind closed doors.  When mistakes are carefully and shamefully hidden they cannot be harnessed as teaching opportunities. Sack demonstrates this point with the example of an accident at the University of Illinois.  Following an incident in which a sponge was left inside of a patient after surgery, the hospital initiated routine X-raying for post-surgery patients.  This practice has resulted in the discovery of eight retained foreign bodies, eight medical errors which would have otherwise gone undetected. 

At the heart of the transparency movement is the value of clear and honest communication between imperfect human beings.  It is encouraging to note that progressive institutions are not only rewarded for strategies to improve medical safety and redress medical negligence, but also for returning humanity to medicine. 

Reference:

Sack, Kevin. (2008, May 18).  Doctors Start to Say 'I'm Sorry' Long Before 'See You in Court'.  The New York Times.

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