Pediatricians Would Admit Error Only Half the Time
MONDAY Oct. 6, 2008 -- Only about half of U.S. pediatricians surveyed in a new study said they'd disclose a medical error to the family of a child under their care.
Many said they were much more likely to admit the error when it was an obvious one.
Medication errors, never a pleasant subject, are particularly tricky when it comes to children and their often protective parents, experts say.
"It's more challenging sometimes with kids because they're more vulnerable and often mistakes can be really serious ones with young children," said Dr. Wendy Levinson, professor and chair of medicine at the University of Toronto. "The stakes and the sense of vulnerability of kids is different."
Levinson is author of an editorial accompanying the new study; both appear in the October issue of the Archives of Pediatrics & Adolescent Medicine.
The issue of medical errors -- and how to prevent or deal with them -- is beginning to get more attention.
"Understanding of when doctors do or don't disclose errors is really an evolving field," Levinson said. "There's a ripple in the background that we know that bad things happen and we make mistakes but we don't talk about them with one another. We're embarrassed about them. We're slowly bringing them to the fore and people are talking about them."
Perhaps even less is known about errors in children, although that knowledge base is increasing as well.
In April, the group that accredits most U.S. hospitals, the Joint Commission, issued guidelines, including standardized weight of children in kilograms, to help prevent medication errors in hospitalized children.
This alert closely followed publication of a study that found that medication errors, including accidental overdoses and adverse reactions, affect about one in every 15 hospitalized children. That number is much higher than previous estimates and underscores growing concerns about medical errors involving hospitalized children -- an issue that generated headlines in November when actor Dennis Quaid's newborn twins were accidentally given life-threatening overdoses of a blood thinner.
And while physicians often express a desire to be open and truthful, actual practice is sometimes quite different.
This survey of about 200 pediatricians working in St. Louis or Seattle revealed marked differences in how physicians said they would disclose an error to children and their families.
Respondents were asked to answer 11 questions about one of two scenarios: In the first, the doctor had administered an overdose of insulin which led to hospitalization of the child; this error was obvious to the family; in the second, the doctor failed to follow up on a lab test, again resulting in hospitalization of the child, but this was less obvious to the family.
A total of 53 percent of respondents said they would definitely disclose errors, with 58 percent claiming they would disclose all details of the error.
About a quarter (26 percent) said they would offer an apology and half said they would talk about ways to prevent a similar error in the future.
Perhaps more troubling, twice as many physicians said they would disclose the error to a parent if the error was a more obvious one (this is in conflict with established ethical standards). Physicians were also more likely to proffer an apology in such a case.
Even when the pediatrician said he or she would disclose an error, the disclosure was often incomplete, the authors found.
"The findings very much fell in line with what we had seen in other specialties that have been surveyed, internal medicine physicians and surgeons specifically," said study author Dr. David Loren, an assistant professor of pediatrics at the University of Washington School of Medicine in Seattle. "[But] our conversations carry more fear and weight because of the people we're disclosing to. They're stewards of children as well, and potentially harming children in our care weighs on the soul heavier."
Fears of malpractice suits, along with basic human emotions, such as shame and embarrassment, not to mention the fact that errors could have long-term repercussions when they occur in children, likely contribute to the general reluctance, the researchers said.
"Barriers that physicians cite to diminishing their enthusiasm for disclosure includes fear of litigation ... and also includes fear of professional censure of some kind, and also just loss of credibility among your peers and those around you," Loren said.
The findings arise during a time when there's been a real shift toward acknowledging and correcting medical mistakes, Levinson said.
"Many institutions are investing a lot of energy building infrastructures to support disclosure. You're not going to disclose if you're out there on your own," she pointed out.
"One way to change behavior in a profession is to provide better educational programs at local levels," Loren added. "We need to do this, and the easier it becomes the stigma [of disclosure] diminishes by the very nature of all of us agreeing it needs to happen."
The regulatory landscape is also changing.
"There are many things lining up here," Levinson said. "First, it's the right thing to do and institutions themselves are building structures to support this, and we have some regulatory and even financial incentives for doing these things."
There's more on preventing medical errors at the Agency for Healthcare Research & Quality.
Posted: October 2008