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Transparency When Things Go Wrong

Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions

Bell, Sigall K. MD*; White, Andrew A. MD; Yi, Jean C. PhD; Yi-Frazier, Joyce P. PhD§∥; Gallagher, Thomas H. MD

doi: 10.1097/PTS.0000000000000153
Original Articles

Objectives Transparent communication after medical error includes disclosing the mistake to the patient, discussing the event with colleagues, and reporting to the institution. Little is known about whether attitudes about these transparency practices are related. Understanding these relationships could inform educational and organizational strategies to promote transparency.

Methods We analyzed responses of 3038 US and Canadian physicians to a medical error communication survey. We used bivariate correlations, principal components analysis, and linear regression to determine whether and how physician attitudes about transparent communication with patients, peers, and the institution after error were related.

Results Physician attitudes about disclosing errors to patients, peers, and institutions were correlated (all P's < 0.001) and represented 2 principal components analysis factors, namely, communication with patients and communication with peers/institution. Predictors of attitudes supporting transparent communication with patients and peers/institution included female sex, US (vs Canadian) doctors, academic (vs private) practice, the belief that disclosure decreased likelihood of litigation, and the belief that system changes occur after error reporting. In addition, younger physicians, surgeons, and those with previous experience disclosing a serious error were more likely to agree with disclosure to patients. In comparison, doctors who believed that disclosure would decrease patient trust were less likely to agree with error disclosure to patients. Previous disclosure education was associated with attitudes supporting greater transparency with peers/institution.

Conclusions Physician attitudes about discussing errors with patients, colleagues, and institutions are related. Several predictors of transparency affect all 3 practices and are potentially modifiable by educational and institutional strategies.

From the *Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; †Department of Medicine, University of Washington, Seattle, WA; ‡Clinical Research Division, Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; §Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA; and ∥Seattle Children's Research Institute, Seattle, WA.

Correspondence: Sigall K. Bell, MD, BIDMC, Division of General Medicine and Primary Care, 330 Brookline Ave, CO 1309, 2nd Fl, Boston, MA 02215 (e-mail:

The authors disclose no conflict of interest.

This project was supported by grants from the Agency for Healthcare Research and Quality (HS016506, T.H.G.), the Robert Wood Johnson Investigator Award in Health Policy Research (T.H.G.), and the Greenwall Foundation (T.H.G.)

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