December 3, 2012
Michelle M. Mello, Lindsey Murtagh, J.D., M.P.H., Thomas H. Gallagher, M.D., and Penny Andrew, M.B.Ch.B.
L. Murtagh, T. H. Gallagher, P. Andrew et al., “Disclosure-and-Resolution Programs That Include Generous Compensation Offers May Prompt a Complex Patient Response,” Health Affairs, Dec. 2012 31(12):2681–89.
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Disclosure-and-resolution is an approach to medical malpractice reform that has attracted recent attention. Hospitals inform patients and families of adverse outcomes, investigate and explain what happened, apologize, and, when appropriate, offer financial compensation. In this Commonwealth Fund–supported study, researchers conducted an online survey to see how people would react to 16 different scenarios involving medical errors, error disclosures or apologies, and compensation offers.
What the Study Found
- Most survey respondents felt their injury would entitle them to financial compensation. However, even under scenarios in which compensation was generous, a majority of respondents were not satisfied. Nearly 60 percent of those offered the highest level of compensation said they felt they should have been offered more.
- Generous compensation offers may have perverse effects. Respondents viewed apologies and disclosures accompanied by higher compensation offers as more motivated by self-interest than apologies and disclosures with lower compensation offers. Although most people said they would accept the compensation offered, many also reported they would seek legal advice.
- While patients may appreciate transparency, harmful errors strain physician–patient relationships, regardless of the resolution process. A strong majority of the survey respondents said they would be likely to change physicians because of the error.
- Respondents presented with serious injury scenarios were significantly more likely than those who received less severe scenarios to seek legal advice, change physicians, and view disclosures as motivated by the desire to avoid lawsuits. They were also significantly less likely to accept offers.
Patients' responses to compensation offers are more complex than might be assumed, the authors conclude. "Creating a clear separation between disclosure conversations and compensation offers may help avoid perceptions that both disclosures and offers are merely strategic behaviors, rather than ethical acts and gestures of goodwill," they write.