In the case of physicians from different institutions, close coordination of the disclosure process is warranted. Physician 2 has an ethical obligation to disclose that long-term alendronate use has been associated with the occurrence of AFFs and may similarly have contributed to the second AFF. After obtaining information about Physician 1’s medical decision making and coordinating communication between medical directors from both institutions, Physician 2 and the institution’s medical director should disclose that alendronate may have contributed to both AFFs.7 Physician 1 should be provided the opportunity to be involved in the disclosure process.
Adequate preparation for the effective disclosure of medical errors is important. Many physicians may lack sufficient training to handle complex and challenging disclosure conversations. Before patient disclosure, the medical team should reach a consensus around the events and decisions that have occurred. The physician should objectively disclose the facts to the patient, subordinating their emotions and ego, in a timely and expedited fashion to maintain trust in the patient–physician relationship. Physicians should seek emotional support via professional counseling and from colleagues after disclosing a medical error, recognizing that error disclosures may lead to significant physician emotional distress.8
As we strive toward building a safer medical system, providing a legal framework that promotes honest disclosure of errors is critical. The Patient Safety and Quality Improvement Act of 2005 provides confidentiality protection for discussion of medical errors within a system of patient safety organizations and a national patient safety database. Nevertheless, many shortcomings remain in the laws that protect healthcare providers who disclose medical errors from litigation.9 Many states have enacted disclosure laws to provide legal protection to physicians who disclose medical errors. However, many states provide protection only to the expression of sympathy after an error, but are not protective of statements of acceptance of responsibility. Notably, there is significant variability between state disclosure laws.
Institutions play a fundamental role in promoting a positive atmosphere for honest disclosure of errors to improve patient safety. Although litigation fear remains a critical barrier for physicians disclosing medical errors, recent studies show that increased disclosure of medical errors, within the context of a disclosure program, does not result in increased legal claims and costs.10,11 For example, implementation of a disclosure-with-offer program at the University of Michigan (compensation offered to patients when an internal investigation reveals medical error) did not increase legal claims and costs.10 Institutions should see errors as an opportunity for system improvement to provide safer care, a critical component of quality improvement programs and a mechanism to improve patient outcomes. Institutions should also strive to provide a disclosure support framework, including basic disclosure training and disclosure coaches who provide technical and emotional support to physicians regarding the disclosure process.11 Promoting conversations between clinicians and providing avenues (both formal and informal) for addressing and discussing errors are vital in supporting a positive disclosure environment.
