August 29, 2006

Another Huge Medical Errors Study: Plato Was Right

The Times covered a survey in Archives of Internal Medicine that replicates umpteen other similar quantitative, survey style reviews of attitudes (or experience) regarding disclosure of medical errors. The authors find, unsurprisingly, that those who believe they are likely to be called out for making a mistake are more likely to reveal the error than those whose mistake is less obvious:
The hypothetical errors were all mistakes that would cause some degree of serious injury. Some were apparent — like leaving a sponge in a surgical patient — and some were less so, like misreading chart data. When the error was obvious, like an improperly written prescription that led to an overdose, 81 percent of doctors said they would definitely disclose the error to a patient. But when presented with an error less apparent, only 50 percent thought it was worth mentioning. One example was a blood chemistry reading that had been overlooked. If it had been noticed, a serious complication would have been prevented.
The less sophisticated these studies get, the more dangerous they are. Previous qualitative studies, beginning of course with the landmark work of Charles Bosk, Forgive and Remember, aim at understanding how the dynamics of iatrogenesis, of error's identification, and disclosure evolve within a social context. The lead author of the present study, Thomas Gallagher, an exceptionally accomplished assistant professor at UDub with a Greenwall Scholar award and an RWJ fellowship with Bernie Lo, understands - develops curriculum even - to deal with the subtleties of disclosure of conflicts and errors. But the methods here are just silly and scary, and the effect is nil. We know no more than we did about how apology affects patients and families - or more important about what Gallagher is really in a position to study, namely how the different ways in which one might actually disclose something would affect patients. Oddly, go figure, an apology from an insensitive physician might be worse than no apology at all. Hmm.

At any rate the data set is huge and it will certainly scare even more people half to death.

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