Should hospitals and physicians be required to disclose their mistakes? This question has recently sparked quite a debate. A recent survey conducted by the Journal of the American Medical Association asked over 200 hospital chief executives and chief operating officers in six states what they thought about state mandated systems for public reporting of errors. Most of the officials felt that such a system would result in fewer incident reports and have a negative effect on patient safety. Over 80 percent of the executives were concerned with a potential increase in lawsuits and believed that the names of hospitals and medical professionals involved with any errors should remain confidential.
The survey responses highlight a growing disagreement between hospital chief executives and patient-safety advocates.
Advocates were galvanized by the results of a study published in 1999 by the Institute of Medicine that reported that somewhere between 44,000 and 98,000 patients die in hospitals every year because of medical mistakes. That means hospital errors kill more Americans than breast cancer does, more than traffic accidents and more than AIDS (Kaiser). Since that report, many hospitals responded by adopting voluntary reporting systems. In fact, over 20 states have mandatory reporting systems, but there is little consistency to their guidelines. Some hospitals collect extensive data while others only record mistakes that result in serious injury.
Almost all programs keep error reports confidential (Wall Street Journal). Proponents of confidential reporting systems believe making names public would shift the attention from fixing problems to blaming people. The other side counters that making these records public would allow hospitals to pool data in order to identify trends that lend themselves to systematic adjustments.
However, in a time where medical malpractice litigation has taken on an ugly life of its own, it’s understandable that some people within the medical community are scared of too much disclosure. That’s a shame for a number of reasons. Researchers from the St. Louis School of Medicine found that patients were unanimous in their desire to be told about any occurrence of harm. The study’s authors wrote, “The patients believed such disclosure would enhance their trust in their physician’s honesty and would reassure them that they were receiving complete information about their overall care.”
Furthermore, most malpractice cases stem from patient dissatisfaction about medical harm generated by the doctor’s attitude and denial, rather than the adverse event itself (Annals of Internal Medicine); however, the most pressing reason to push for a culture of disclosure is that anything less could delay appropriate medical responses.
The Journal of the American Medical Association has also published several studies that found doctors who are open and honest about their mistakes are more likely to learn from these episodes then their colleagues who remain silent.
It seems that we are at an impasse because both doctors and patients have lost sight of what it takes to practice good medicine. Doctors are people, not machines. They will make mistakes. The question becomes, how can we minimize their seriousness and frequency? Answering that question requires public disclosure of error statistics. That won’t happen until doctors believe they won’t be fired or sued if they accept responsibility for their mistakes, which means patients have to trust their doctors to be rigorous, with high ideals of excellence and good intent. We all need to be committed to improving medical interactions more than covering our butts or extracting the proverbial pound of flesh.