November 1, 2013

NEJM: Doctors should report a colleague's mistakes. Here's how.

Daily Briefing

    Doctors who observe a colleague's medical mistake have a moral responsibility to disclose it and ensure that it is communicated to the affected patient, according to new guidelines published in NEJM this week.

    Preventable medical mistakes—including medication dosing errors, undetected tumors, and even equipment left inside a patient's body after surgery— are an "everyday occurrence" at hospitals nationwide, experts say. Such adverse events are estimated to cause as many as 440,000 patient deaths a year—a statistic that would make medical errors the third-leading cause of death in the United States.

    However, doctors and other providers are resultant to disclose their own medical errors—much less those made by their colleagues. That reluctance has impeded efforts to improve hospital safety, the NEJM report authors argue.

    "Progress on patient safety has been much more limited than anyone would like," says Thomas Gallagher, a University of Washington professor of medicine and bioethics who led the group that created the guidelines. "We haven't made enough headway in improving communication. The difficulty physicians have in communicating with one another when something goes wrong is an important factor," he adds.

    Guidelines urge doctors to 'explore, don't ignore'

    The new guidelines offer explicit instructions to doctors and hospitals on communicating with patients about colleagues' harmful errors. The guidelines call for an "explore, don't ignore" approach to mistakes that includes talking directly and respectfully with colleagues.

    Whereas before, being a good colleague meant "not saying anything, having their back, when you think they've made a mistake," the new guidelines ask "people to turn toward their colleagues in those instances," Gallagher says.

    The guidelines also stress the need to establish a clear action plan for talking with patients, particularly those who have been harmed by a medical mistake. Patients "should not bear the burden of digging for information" about problems related to their treatment, the guidelines say.

    An evolving medical culture

    The University of Illinois Hospital and Health Sciences System's Michael Bresler says the guidelines make sense in a changing medical culture that does not excuse negligence, but he acknowledges that doctors are human.

    Thirty-seven states now allow doctors to apologize to patients without it being used against them in court. The University of Michigan Health System, an early adopter of the policy, found that apologizing for medical errors reduced overall malpractice and claim costs.

    Helping doctors address their peers' mistakes is another step in the long effort to reduce medical errors, says Gallagher, adding, "I'm more excited now than I've ever been about the potential for really transformative change…but I think we've got a long ways to go" (Aleccia, NBC News, 10/30).

    More from today's Daily Briefing
    1. Current ArticleNEJM: Doctors should report a colleague's mistakes. Here's how.

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