The Disclosure Debate: Say Sorry or Sweat Suit

A new study raises the age-old question in medicine of when a medical error occurs, do you play offense and deal with it head-on or take a defensive position instead?

The study examines the University of Michigan Health System’s medical error full disclosure policy. The policy states that patients and their families are told when an error is made, who made it, how it happened, and what steps were taken to fix both the error and avoid future reoccurrences. In addition to the apology, there is also an offer of fair compensation.

Published in the Annals of Internal Medicine, the study indicates that in reviewing claims from 1995 to 2007, researchers saw decreased activity in new legal claims, including lawsuits per month, time to claim resolution and total liability costs following the use of the policy.

The study’s lead author, Allen Kachalia, MD, of Boston’s Brigham and Women’s Hospital, notes that the decrease in claims and costs could be attributed to factors including the fact that patients may be less likely to take the legal route when given prompt transparency and an up-front offer of compensation.

With this in mind, the researchers hope that the study will alleviate some fears in disclosure of medical errors and encourage greater transparency in medicine. In addition to reducing legal costs, the researchers are seeking a change in the culture of healthcare, indicating that admitting mistakes increases patient trust and makes physicians better at their jobs by learning from their mistakes.

Essentially, honesty is the best policy.

However, one study is unlikely to change the very real fear that disclosing each and every medical error – no matter how big or how small – could lead to greater malpractice claims and costs.

In fact, you need to delve a little deeper in to the matter and consider two important parts of the study beyond the headlines: one, Michigan has reformed medical malpractice laws including a six-month “cooling off period” prior to parties heading to court; and two, the University of Michigan’s physicians are self-insured for malpractice coverage through the school.

While I applaud the survey results and actually think being more open and honest with patients is a very good thing, I wonder whether smaller, private practices would find the same success given their malpractice coverage. Would they too see a drop in legal costs?

So consider your practice. Let’s say starting next week, you begin to duplicate the University of Michigan’s policy of being apologetic and offering concessions to patients when errors occur.
What do you think the result will be?