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Doctors Willing to Admit Mistakes, But Unsure About Process

By Greg Vadala, CQ Staff

Most doctors are willing to report and share information about medical mistakes but lack adequate systems to do so, according to a recent government study.

The report, funded by the Agency for Healthcare Research and Quality (AHRQ), found that a majority of physicians agreed that reporting mistakes to their hospitals or health care organizations would improve patient safety. But it also found that doctors were more likely to discuss errors with their colleagues in informal settings than to report them to risk management or patient safety programs.

As a result, the study's authors contend, hospitals and health care organizations are left out of the loop when it comes to critical information about the occurrence and prevention of medical mistakes.

"Physicians say they want to learn from errors that take place in their institution to improve patient safety," AHRQ Director Carolyn M. Clancy said in a statement. "We need to build on that willingness with error-reporting programs that encourage their participation."

The study, which was published in the January/February issue of Health Affairs, was based on an anonymous survey of more than 1,000 physicians currently practicing in urban and rural areas in Missouri and Washington state. The 68-question survey, which was conducted between July 2003 and March 2004, asked doctors about their attitudes toward and experience with discussing and reporting mistakes with their colleagues and institutions.

"If you're a physician for long enough, you're going to be involved in an error," Dr. Jane Garbutt, the study's lead author and an assistant professor of medicine at Washington University in St. Louis said.

Fifty-six percent of the doctors surveyed said that over the course of their careers they had been involved with an error that "causes permanent injury or transient but potentially life-threatening harm." In addition, 74 percent were involved with a mistake that "causes harm that is neither permanent nor potentially life-threatening."

While only 27 percent of the respondents received information about mistakes from their hospital, health care organization, or a patient safety program, 68 percent said they received information about errors from fellow doctors.

The authors noted that the study challenges the longstanding notion that doctors are "reluctant partners" in reporting mistakes to the hospitals where they practice. However, they conceded that there are still major barriers to encouraging doctors to use hospital-based reporting systems, including the "culture of perfectionism" in the profession and a fear of negative consequences, such as malpractice litigation or disciplinary action.

Another obstacle to consider is the general lack of awareness about reporting mechanisms, they said. Garbutt said that one of the most striking findings was that 45 percent of doctors did not know if a reporting system designed to improve patient safety even existed at their hospital or health care organization.

About 36 percent of respondents reported access to a reporting system, while 19 percent reported having no access, according to the study.

"What they wanted more than anything else was information about how to prevent the most common errors," Garbutt said. "They want to learn how to improve."

Garbutt cautioned that policy makers looking to address the issue must consider the differences in attitudes and behaviors between surgeons and medical specialists.

According to the study, surgeons were more likely than other specialists to attribute mistakes to the failure of individuals rather than systems and also were more likely to have discussed errors with their colleagues.

In discussing possible solutions, Garbutt cited the example of a Web-based reporting system used by neonatal intensivists from several institutions. She said that the group's use of an e-mail discussion list and interaction through a series of meetings kick-started several improvement projects related to patient safety.

"It's a model that's worth investigating," Garbutt said.

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