CMAJ • November 6, 2007; 177 (10). doi:10.1503/cmaj.1070114.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Disclosing medical errors

W. Ward Flemons, MD*, Jan M. Davies, MSc MD{dagger} and Bruce MacLeod, MD{ddagger}

*Vice President, Quality, Safety and Health Information, Calgary Health Region; {dagger}Professor of Anesthesia, University of Calgary; {ddagger}Medical Director, Clinical Safety Evaluation, Calgary Health Region, Calgary, Alta.

The commentary on disclosing errors to patients by Wendy Levinson and Thomas Gallagher1 perpetuates the confusion created by others.2,3 Levinson and Gallagher suggest that errors alone lead to harm; if harm is not caused, it is "by chance or because the error was corrected before harm could occur." Statements like this suggest that they have not based their writing on a model of accident causation, such as Reason's well-referenced "Swiss cheese" model,4 which describes the complex interplay of the actions of workers, local triggering factors and latent conditions that weaken, breach or bypass defences, thereby contributing to adverse outcomes. Statements such as "some adverse events are preventable — these events can be called errors" are inaccurate; the terms error, adverse event and harm are not synonymous.

Levinson and Gallagher make reference to national guidelines for the disclosure of adverse events that the Canadian Patient Safety Institute is developing with stakeholders "including the Canadian Medical Protective Association and organizations that represent medicine, nursing, pharmacy and health care institutions."1 We find it curious that patients and their families, the most important stakeholders, are not mentioned in this list. The guidelines use an arbitrarily chosen definition of an adverse event: "an unexpected event in health care delivery that results in harm and is not attributable to a recognized complication."5 This definition markedly restricts the scope of disclosure and is not patient focused.

For patients, the distinctions between the terms errors, adverse events and unexpected complications are not important. Patients experience harm, and regardless of how members of the health care community and legal profession wish to classify it, patients who have suffered harm expect and deserve a timely, supportive and informative conversation about their concerns. Indeed, in 2003 the College of Physicians and Surgeons of Ontario recognized this with the publication of their policy on disclosure of harm.6

Footnotes

Competing interests: None declared.


REFERENCES

  1. Levinson W, Gallagher TH. Disclosing medical errors to patients: a status report in 2007. CMAJ 2007;177:265-7.[Free Full Text]
  2. Waite M. To tell the truth: the ethical and legal implications of disclosure of medical error. Health Law J 2005;13:1-33.[Medline]
  3. Lemon MR, Hobgood C, Hevia A. Disclosing medical error: a professional standard. Semin Med Pract 2004;7:24-33.
  4. Reason J. Managing the risks of organizational accidents. Aldershot (UK): Ashgate Publishing; 1997.
  5. Canadian Patient Safety Institute. Draft national guidelines for the disclosure of adverse events. Edmonton: The Institute; 2007. Available: www.patientsafetyinstitute.ca/disclosure.html (accessed 2007 Sept 12).
  6. College of Physicians and Surgeons of Ontario. Disclosure of harm. Policy no 1-03. Toronto: The College; 2003. Available: www.cpso.on.ca/Policies/disclosure.htm (accessed 2007 Sept 12).




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