Pediatricians have a wide range of approaches towards disclosing medical errors to patients and their families, and they may be less likely to disclose this information if the errors are less obvious to parents, according to an article released on October 6, 2008 in Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.
Medical errors occur in all fields of medicine. Patients generally feel strongly that they should be told about these errors, and most doctors, ethicists, and professional organizations agree, though the patient may not always be fully informed. In pediatrics, this is also true, but due to the patient’s status, it is also necessary to inform the parents. According to the article, this does not always occur. The authors say: “Disclosing an error to one or both parents, and possibly to the child as well, may prove to be an exceptionally challenging conversation.”
To investigate the behaviors of pediatricians when faced with medical errors, David J. Loren, M.D., of the University of Washington School of Medicine, Seattle, and colleagues performed a survey as part of a cross-sectional study. A total 369 pediatricians were canvassed, and 205 responses were received. The responding population was made up of 176 attending physicians and 29 trainees.
The survey asked 11 questions about one of two situations, which were randomly assigned. In one, the pediatrician hypothetically administered an overdose of insulin resulting in admission of the child to the intensive care unit, an outcome clearly observable by the family. In the second, the physician failed to follow up with one of the patient’s laboratory tests, eventually resulting in an infection and subsequent hospitalization, an outcome that was considered less obvious to parents.
In tabulating the results, the following proportions of responses were observed regarding the errors:
- 79% described either error as serious.
- 83% said they would feel very or extremely responsible.
- 44% said they would be concerned that the error could cause damage to their reputations.
The following proportions of responses were observed regarding each doctor’s hypothetical responses to the errors:
- 53% said they would definitely disclose the error.
- 40% said they would probably disclose the error.
- 14% said they would disclose the error only if asked by the parent.
- 46% said they would use the word “error” when disclosing the information.
- 54% said they would include an explicit apology which acknowledged the harm caused to the child.
- 50% said they would explain detailed plans for the prevention of future errors.
Notably, differences were observed between respondents who received the more apparent error scenario (with the intensive care unit admission) than to the less apparent error scenario (with the infection leading to hospitalization:) Twice as many doctors who received the apparent error would disclose the error, and more would offer an explicit apology.
Pediatric medical errors offer special challenges to doctors, because they must accommodate various individual levels of understanding on the part of each child. Additionally, children may be viewed as completely helpless, there may be a lack of information about how an error will affect the child’s development, and there is a long statute of limitations for the harm that may be caused to a child due to a physician. For all of these reasons, pediatric physicians have many effects that could modify their disclosure methods and decisions.
The authors note that trust is extremely important in the pediatric patient-doctor-parent relationship, and this trust may be complicated by the occurrence of a medical error. “In conclusion, the relationship among a pediatrician, a child and a family is steeped in trust, a commodity that can be significantly diminished by the occurrence of a medical error,” say the authors.. “Nevertheless, parents have clearly articulated a desire to be told about errors in the medical care of their children. This study demonstrated marked variation in when and how pediatricians might disclose medical errors and found that they may be less likely to disclose an error that was less apparent to the family. Further research on the impact of professional guidelines and innovative educational interventions is warranted to help diminish the disparity between patient preferences for disclosure and current professional behavior.”
Medical Error Disclosure Among Pediatricians: Choosing Carefully What We Might Say to Parents
David J. Loren; Eileen J. Klein; Jane Garbutt; Melissa J. Krauss; Victoria Fraser; W. Claiborne Dunagan; Dena R. Brownstein; Thomas H. Gallagher
Arch Pediatr Adolesc Med. 2008;162(10):922-927.
Written by Anna Sophia McKenney