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7 Medical Error Disclosure Deterrents

Julie McCoy, for HealthLeaders Media, February 9, 2011

The admission of making a mistake resulting in damage to patient trust and threat of litigation is a weight on the minds of all physicians.

Failing to address the values of error, near miss, and unsafe condition reporting with residents is detrimental to both the institution and the trainee, says David Mayer, MD, associate dean of curriculum, associate professor of anesthesiology, and coexecutive director of the Institute for Patient Safety Excellence at the University of Illinois at Chicago (UIC). 

If residents fail to report errors and unsafe conditions, the institution misses opportunities to improve systems in the hospital that affect quality. They also miss a valuable teaching opportunity for their residents, Mayer says.  

Not to mention that medical errors are extremely taxing and stressful for residents, says Sigall K. Bell, MD, assistant professor of medicine in the Division of Infectious Disease at Harvard Medical School in Boston. Bell, who has coauthored academic articles on the topic, says the following issues often make residents apprehensive about disclosing and reporting errors or adverse events: 

1. Emotional distress. Residents are often trained under the assumption that physicians do not and cannot make mistakes; the pressure for perfection can be immense. After an error, many residents feel fearful, alone, and guilty. They worry about the harm caused to their patient, their career, and their future.

2. Experience-proficiency balance. Defining medical errors in the context of teaching hospitals is difficult because residents are still learning and need clarification on what to report. 

For example, during a conversation about medical errors, Bell says a trainee asked whether taking three tries to find the cervix during a pap smear is considered a medical error. "It's an interesting question," Bell says. "Where do you draw the line on proficiency? You need experience to gain proficiency, but in many cases you need proficiency to get the experience." Trainees struggle with striking a balance between safely gaining experience and proficiency. 

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