Error Disclosure and Building Trust

Originally posted 12-6-2010:
I'm a believer in open and honest communication.  I have always found that it builds trust and can help solve problems before they can get out of hand.  That's why I was intrigued by this article regarding patient perceptions on Medical Error disclosure. A survey of patients in Illinois revealed they would "more forgiving" if they believe their physicians would inform them of a medical error occurring. The article goes on to say that patients prefer disclosure of medical errors, but usually a "deny and defend" policy is in place when errors occur. It is hard to believe that this sort of information would be kept from patients. But according to the article, the fear of lawsuits and ruined reputation causes the lack of disclosure. 

I recently heard a story through a friend about someone who just had a baby.  After the delivery, the baby wasn't crying and all the nurses and doctors were huddled around the baby in the corner. Any healthcare professional would know this as a sign that the infant wasn't breathing and needed to be resuscitated on the spot.  Luckily the baby survived and seems to be okay.  The part of the story I couldn't believe was the mother was later told, the "baby forgot to cry."  I'm does a newborn forget to cry?  I understand not trying to cause extra concern and worry, but I think the mother has a right to know what really happened.  How does lying about this help anyone, when there could have been some risks the parents may have needed to be aware of?

Granted, that wasn't necessarily a medical error, but it was still a situation that lacked honest communication. What this ultimately does is affect the trust between patients and physicians. If physicians are worried about lawsuits, then they won't be up front about disclosing medical errors.  Patients will have trouble trusting their physicians if they suspect secrets are being held from them. 

This lack of trust hurts communication.  I've argued that patients need to be part of the medical error feedback loop to help find where the system can be fixed.  However, this feedback loop will not be effective without that open communication and trust.  As the article encourages, policies that address error disclosure is one step in the right direction to build that trust and improve the important patient feedback channels.