Study Finds Doctors Not Reporting Medical Mistakes

TUESDAY Jan. 15, 2008 -- Almost two-thirds of doctors say they are willing to report medical errors, but many of them just don't do it, a new study finds.

"The most important message seems to be that there is a gap between physicians' desire to report errors to improve performance over time and reporting of errors," said study author Dr. Lauris Kaldjian, an associate professor of medicine at the University of Iowa Carver College of Medicine. His study of 338 doctors from teaching hospitals across the country is published in the Jan. 14 issue of the Archives of Internal Medicine.

The study showed glaring differences between theory and practice. While 73 percent of the doctors said they would disclose any medical error that caused minor medical harm, and 92 percent said they would report an error that caused major damage, such as death or disability, only 18 percent said they had actually reported minor errors, while only 4 percent said they had made a major error and reported it.

Even more troubling, 17 percent acknowledged having made a minor error and not reporting it, while 4 percent indicated having made but not disclosed a major error.

The occurrence and reporting of medical errors became a big issue in 1999, when the U.S. Institute of Medicine issued a report, To Err Is Human, which estimated that the deaths of more than 100,000 Americans are tied to some form of medical mistake.

One big reason for the reporting gap appears to be that many physicians are unfamiliar with the reporting process, Kaldjian said. "We found that only about 55 percent of the respondents knew how to report errors," he said. "Only 40 percent knew what kind of errors should be reported."

The findings echo previous research on the issue, said Dr. Thomas Gallagher, an associate professor of medicine at the University of Washington who has conducted numerous studies on how errors are handled by the medical profession.

"The gap comes from a number of areas," Gallagher said. "Physicians are unfamiliar with the reporting process and their role in it. And a fair number of physicians are not certain how the process works. More important, physicians often are skeptical about whether reporting will have an impact on the quality of medical care that they would like it to."

More feedback from hospitals when an error is reported could improve the situation, Kaldjian said. "It is all the more important that hospitals be clear about why they have this reporting system and how the information from it will be used," he said.

The reporting situation is improving, but slowly, Gallagher said. "Physicians are more aware of the importance of reporting, but there is a long way to go," he said.

Federal regulations requiring that medical mistakes be reported to a central fact-gathering body is helping to actually improve medical practice, Gallagher said.

"It advances hospitals' ability to sort out which adverse events are more likely," he said. "But this is a slow process. Hospitals are slow to learn from one another. Still, physicians are deeply committed to improving the quality of care. As they learn they can report errors without punitive consequences, their reporting practices will improve."

The Kaldjian study did find evidence of positive feedback. Doctors who reported minor medical errors in the past said they were more likely to report any new errors.

Posted: January 2008


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