The error of our ways

We are not entirely surprised by Michael Aubrey's rather strong reaction to our article.1 Indeed, we believe his views may be shared by other physicians. Aubrey's main concern is not, however, an ethical one, but rather one arising out of legal prudence. This caution is based on the feared ill consequences of disclosure for the physician — that revelation of error might increase the risks for successful malpractice actions against him or her. Experience, reason and, perhaps most importantly, current research should allow the practice of medicine to move beyond this fear.

Research suggests that honesty with patients and their relatives about medical error tends to strengthen the physician–patient relationship and so reduces the likelihood of lawsuits and professional misconduct hearings. Disclosure that is thorough and timely prevents the feelings of dissatisfaction and discontent that are often the real trigger for complaints against physicians. Thus, even seen from a narrow “prudential” approach, honesty with patients about error is generally the best policy. Such disclosure need not, and indeed should not, imply negligence or malpractice by anyone.

Currently, when medical error results in harm and, in turn, creates financial hardship for a patient (such as loss of employment), the patient has only one way to seek compensation for his or her losses: through the legal system. Is Aubrey suggesting that patients who have suffered serious injury owing to medical error be prevented, by lack of honesty about what caused the injury, from exercising their right to seek needed compensation? Such dishonesty would compound the harm suffered by the patient and be a breach of professionalism.

True professionals admit their errors, seek to understand them and prevent them for recurring, and move on. Candidly disclosing harmful errors to patients simply closes the loop of learning, compassion and trust that is the foundation of the practice of medicine. Yes, being sued can be painful and perhaps even destructive. But it would be far worse, for individual patients and for society, if we failed to use the commission of an error as an impetus to be frank about our mistakes and as an opportunity to improve patient safety.