Medical error: Overcoming barriers to truthful disclosure



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The Institute of Medicine’s report on medical errors revealed a degree of fallibility in health care that was previously unrecognized. One explanation for the\r\ngeneral ignorance about the threats to patient safety and actual harms to patients is that\r\nmany health-care providers are reluctant to disclose errors to patients or their family\r\nmembers, despite widespread agreement that telling the patient or the patient’s surrogate\r\nthe truth about a medical error is the physician’s professional and ethical duty.\r\nThere are a number of reasons for health-care providers’ decisions to conceal the\r\ntruth or misrepresent what happened when medical error occurs. They range in character\r\nfrom the philosophical to the bureaucratic. Discussions about resolving the problems\r\nsurrounding medical error tend to focus on the systemic nature of many medical errors,\r\nways to improve patient safety, doing away with blame and punishment for erring health\r\nprofessionals, and reforming malpractice legislation. Although each of these explanations\r\nand solutions has its merits, all fail to adequately address the role of the culture of\r\nmedicine in perpetuating the reluctance to truthfully disclose medical errors and the need\r\nfor culture change in health care. There is more to culture change than tinkering with\r\nautomation, organizational policies, and caps on malpractice damages.\r\nA humanistic inquiry, this dissertation reviews and critiques explanations of what\r\nhappens to the erring health professional when faced with owning up to his or her\r\nmistake, reviews and critiques the solutions to the problems surrounding medical error\r\nand deception, and offers alternative ways of understanding and addressing the policies\r\nand ethics of medical error disclosure.



tort reform, patient safety, medical malpractice, deception, culture of medicine