To err is human, but also in healthcare? Communicating medical errors to patients and families

Author/s Giulia Lamiani, Stefania Anania
Publishing Year 2015 Issue 2015/3 Language Italian
Pages 17 P. 527-543 File size 197 KB
DOI 10.3280/RIP2015-003006
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

In the last ten years the problem of medical errors received an increasing attention in the public and scientific debate. Although new organizational practices have been introduced to decrease medical error, communicating it to patients and families remains a dreaded and avoided practice. Literature highlights that there are cultural, legal and psychological issues that prevent clinicians from honestly disclosing medical errors to patients. Given the sensitivity of the research topic, few international studies analyzed the communication during error disclosure. In this work we analyze two consultations in which "real" clinicians disclose a medical error to a family member portrayed by an actor. The consultations were collected during an educational workshop on disclosure of medical error at San Paolo Hospital, University of Milan. The considerations suggested by the analysis of the consultations regard the clinicians involved, the timing of disclosure, the words used to communicate, and the role of apologies. If effectively disclosing medical errors is becoming a benchmark of good practice, training and emotional support should be offered to clinicians.

Keywords: Clinician-patient communication, medical error, apology, reparation, clinical psychology, qualitative research methodology

  1. Avitto, F.M. (2014). Contenzioso medico. La guerra degli spot in TV. Medici contro avvocati: "Siete avvoltoi". E si minacciano querele. Quotidianosanita. it..
  2. Banja, JD. (2004). Medical errors and medical narcissism. Sudbury, MA: Jones and Bartlett Publishers.
  3. Blendon, R.J., DesRoches, C.M., Brodie, P.H.M., Benson, J.M., Rosen, A.B., Schneider, E., Altman, D.E., Zapert, K., Herrmann, M.J., & Steffenson, A.E. (2002). Views of practicing physicians and the public on medical errors. New England Journal of Medicine, 347, 1933-1940. DOI: 10.1056/NEJMsa022151
  4. Chan, D.K., Gallagher, T.H., Reznick, R., & Levinson, W. (2005). How surgeons disclose medical errors to patients: a study using standardized patients. Surgery, 138, 851–858.
  5. CINEAS. (2002). Quando l’errore entra in ospedale. Risk Management: Perche sbagliando si impari. Le mappe del rischio, le soluzioni.
  6. Crigger, N.J., & Meek, V.L. (2007). Toward a theory of self-reconciliation following mistakes in nursing practice. Journal of Nursing Scholarship, 39, 177-183. DOI: 10.1111/j.1547-5069.2007.00164.x
  7. Crocetti, G., & Pallaoro, G. (2007). Manuale di pratica clinica e teoria della tecnica infanzia. Roma: Ed. Armando.
  8. D’Amico, P. (2008). L’ Ordine: “Cause quintuplicate in un anno. Depenalizzare le colpe mediche”. Corriere della
  9. De Trizio, N., Vergari, B., Vergari, F., & Zanardi, L. (2007). L’errore medico: studi per la rilevazione, analisi del fenomeno, proposte operative e legislative.
  10. Federazione Nazionale degli ordini dei Medici Chirurghi e degli Odontoiatri (2014). Codice di deontologia medica.
  11. Fein, S.P., Hilborne, L.H., Spiritus, E.M., Seymann, G.B., Keenan, C.R., Shojania, K.G., Kagawa-Singer, M., & Wenger, N.S. (2007). The many faces of error disclosure: a common set of elements and a definition. Journal of General Internal Medicine, 22, 755-61. DOI: 10.1007/s11606-007-0157-9
  12. Flamigni, C., & Mengarelli, M. (2014). Nella mani del dottore? Il racconto e il possibile futuro di una relazione difficile. Milano: FrancoAngeli Editore.
  13. Gallagher, T.H., Waterman, A.D., Ebers, A.G., Fraser, V.J., & Levinson, W. (2003). Patients’ and physicians’ attitudes regarding the disclosure of medical errors. The Journal of the American Medical Association, 289, 1001–1007. DOI: 10.1001/jama.289.8.1001
  14. Gallagher, T.H., Waterman, A.D., Garbutt, J.M., Kapp, J.M., Chan, D.K., Dunagan, W.C., Fraser, V.J., & Levinson, W. (2006). US and Canadian physicians’ attitudes and experiences regarding disclosing errors to patients. Archives of Internal Medicine, 166, 1605-1611. DOI: 10.1001/archinte.166.15.1605
  15. Gallagher, T.H. (2010). Criteria of effective error disclosure. Unpublished coding scheme.
  16. Gawande, A. (2010). The Checklist Manifesto: How to Get Things Right. New York: Metropolitan Books. (Trad it. Checklist: Come fare andare meglio le cose, Milano: Einaudi).
  17. Gorini, A., Miglioretti, M., Pravettoni, G. (2012). A new perspective on blame culture: an experimental study. Journal of Evaluation in Clinical Practice,18, 671-675. DOI: 10.1111/j.1365-2753.2012.01831.x.
  18. Hannawa, A.F. (2014). Disclosing medical errors to patients: effects of nonverbal involvement. Patient Education and Counseling, 94, 310-313. DOI: 10.1016/j.pec.2013.11.007
  19. Hobgood, C., Peck, C.R., Gilbert, B., Chappell, K., & Zou, B. (2002). Medical errors-what and when: what do patients want to know? Academic Emergency Medicine, 9, 1156-1161. DOI: 10.1197/aemj.9.11.1156
  20. Jenks, C.J. (2011). Trascribing text and talk. Amsterdam: John Benjamins.
  21. Kachalia, A., Shojania, K.G., Hofer, T.P., Piotrowski, M., & Saint, S. (2003).
  22. Does full disclosure of medical errors affect malpractice liability? The jury is still out. Joint Commission Journal on Quality and Patient Safety, 29, 503-511.
  23. Kaldjian, L.C., Jones, E.W., Wu, B.J., Forman-Hoffman, V.L., Levi, B.H., & Rosenthal, G.E. (2007). Disclosing medical errors to patients: attitudes and practices of physicians and trainees. Journal of General Internal Medicine, 22, 988-996. DOI: 10.1007/s11606-007-0227-z
  24. Lamiani, G., Leone, D., & Vegni, E. (2011a). La comunicazione dell’errore. Valutazione di un progetto formativo. MEDIC, 19, 69-75.
  25. Lamiani, G., Meyer, E. C., Leone, D., Vegni, E., Browning, D.M., Rider, E.A., Truog, R.D., & Moja, E.A. (2011b). Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare. Medical Teacher, 33(2), e57-64. DOI: 10.3109/0142159X.2011.534207
  26. Leone, D., Lamiani, G., Vegni, E., Larson, S., & Roter, D. (2015). Error disclosure and family members’ reactions: Does the type of error really matter? Patient Education and Counseling, 98, 446-52. DOI: 10.1016/j.pec.2014.12.011
  27. Mazor, K.M., Goff, S.L., Dodd, K.S., Velten, S.J., Walsh, K.E. (2010). Parents’ perceptions of medical errors. Journal of Patient Safety, 6, 102-107. DOI: 10.1097/PTS.0b013e3181ddfcd0
  28. Meyer, E.C. (2014). Courage, brains and heart: Lessons from the Wizard of Oz for difficult healthcare conversations. Australian Critical Care, 27(3), 108-109. DOI: 10.1016/j.aucc.2014.03.002
  29. Pascucci, L. (2009). La Riparazione. Materiale clinico, contributi teorici e nuove prospettive di analisi.
  30. Reasons, J. (2000). Human error: models and management. British Medical Journal, 320, 768-70.
  31. Schwappach, D.L., Koeck, C.M. (2004). What makes an error unacceptable? A factorial survey on the disclosure of medical errors. International Journal for Quality in Healthcare, 16, 317-26. DOI: 10.1093/intqhc/mzh058
  32. Studdert, D.M., Mello, M.M., Gawande, A.A., Brennan, T.A., & Wang, Y.C. (2007). Disclosure of medical injury to patients: an improbable risk management strategy. Health Affairs Millwood, 26, 215-226. DOI: 10.1377/hlthaff.26.1.215.
  33. Truog, R.D., Browning, D., Johnson, J., & Gallagher, T. (2011). Talking with patients and families about medical errors. Baltimore: Johns Hopkins University Press. (Trad it. Errori medici. La comunicazione con il paziente e i familiari. Milano: Raffaello Cortina).
  34. White, A., Waterman, A., McCotter, P., Boyle, D., & Gallagher, T. (2008). Supporting healthcare workers after medical errors: considerations for health care leaders. Journal of Clinical Outcomes Management, 15, 240-247.
  35. Wu, A.W., Cavanaugh, T.A., McPhee, S.J., Lo, B., & Micco, G.P. (1997). To tell the truth: ethical and practical issues in disclosing medical mistakes to patients. Journal of General Internal Medicine, 12, 770-775. DOI: 10.1046/j.1525-1497.1997.07163.x
  36. Wu, A.W., Folkman, S., McPhee, S.J., & Lo, B. (1991). Do house officers learn from their mistakes? Journal of American Medical Association, 265, 2089-2094. DOI: 10.1136/qhc.12.3.221

Giulia Lamiani, Stefania Anania, Sbagliare è umano, ma anche in medicina? La comunicazione degli errori ai pazienti e ai familiari in "RICERCHE DI PSICOLOGIA " 3/2015, pp 527-543, DOI: 10.3280/RIP2015-003006