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Medical errors and ethics: A call for candor without fear

Physicians have an ethical responsibility to lend their expertise to solving the medical errors conundrum.

Editorial. July 21, 2003.

It's now been four years since the Institute of Medicine shocked and awed patients and medical professionals alike with its report that at least 44,000 people die each year from medical errors in hospitals.

Since then, much discussion has focused on how to change procedures and how to install mechanisms to effectively reduce medical errors. These efforts are likely to get a significant boost from an AMA Council on Ethical and Judicial Affairs report that clearly defines the medical profession's ethical responsibility to improve safety and patient care.

With this article   See related content   Topic: Liability crisis

CEJA recommended, and the AMA House of Delegates agreed, that physicians should play a key role in identifying medical errors and in studying ways to prevent them. The CEJA recommendations enacted also said that physicians should participate in developing reporting mechanisms that emphasize education and system change.

But CEJA, recognizing that efforts at shoring up the infrastructure of the patient safety system already have been the subject of conferences, studies and legislation, also decided to broaden its look at the physician's ethical responsibilities in this arena. "When patient harm has been caused by an error," according to the CEJA report, "physicians should offer a general explanation regarding the nature of the error and measures being taken to prevent similar occurrences in the future."

This is as it should be.

As CEJA points out, there is a tradition of honesty and compassion in medical ethics. This tradition is emphasized in the Code of Medical Ethics, which specifically addresses those occasions when a patient "suffers significant medical complications" from a physician's mistake or judgment.

"In these situations, the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred," the code states.

CEJA acknowledges that in today's rough medical liability climate, imparting information about errors seems counterintuitive. But the council makes the argument that recent studies have shown that reaching out to patients and disclosing errors actually may help alleviate patient discontent and help maintain patient confidence. It is even possible that it's one way to reduce the risk of professional liability.

Indeed, some states have taken steps to sever the link between a disclosure of a medical error and a lawsuit by passing legislation that ensures any apology to a patient who was harmed as a result of an error cannot be presented as evidence in medical liability lawsuits. They have embraced the idea that patients should not feel abandoned after a medical error and that physicians should reach out to their patients.

Legislation of this type should go far in allaying physicians' fears about being sued after an apology.

In broader terms, CEJA called for physicians to push for changes to the current legal system that would allow for errors to be "safely and securely reported and studied as a learning experience for all participants in the health care system, without threat of discoverability, legal liability or punitive action."

The march toward a safer health care system must continue. Physicians should lead the way. Central to that is the ability to disclose and to examine medical errors without fear.

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Copyright 2003 American Medical Association. All rights reserved.

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