Saturday, January 28, 2012

Teaching on Disclosure of Medical Errors

I’ve been a teaching physician for a bit over 10 years now.  One of the great things about teaching learners about medicine is that in doing so, I myself learn something every day.  There are so many things to learn in medicine.  Sure, a lot is “medical content”, but there are so many other things.  How to “connect” with a patient, how to interact with other health care professionals, how to improve adherence: all of these are some of the “softer” sides of medicine—but just as important as the newest drug for managing a particular disease.
Since 2003, I have been privileged to teach quality improvement principles to residents.  While what we were doing was “innovative” in 2003, now it is no longer innovative: it is REQUIRED.  Teaching what I call "the science of improvement" is very exciting to me, and demonstrates how advances in medicine move forward. 
One area within quality improvement that is particularly exciting to teach about is Disclosure of Medical Errors.  What this means is that we realize that errors occur, and rather than hiding them, we (the medical community) should tell patients about these errors.  Literature is now actually supporting the fact that when errors are disclosed, patients/families are LESS likely to be sue physicians, not more likely.
While this is fascinating information to me, the real impetus should not be about getting sued versus avoiding a lawsuit: it should be about doing the right thing for patients.  It has been fascinating to read the literature on this topic, and how it has “pushed the envelope” towards doing the right thing for patients which ultimately improve patient care.  Authors such as Tom Gallagher and Wendy Levinson (from the University of Washington, and the University of Toronto, respectively) have written on this topic for years, and have really advanced the field.
While reading some posts on Twitter today, Mike Moore, a medical student in the Seattle area posted a link to this outstanding TED talk on Disclosing Errors by Dr. Brian Goldman.  Wow.  This is absolutely worth watching, and should be required for medical students and residents (as well as teaching and practicing physicians).
So how should medical schools teach about Disclosure of Medical Errors?  If it isn't happening, it is time to do so.  If it has been integrated, kudos are in order: it is an important tenet of quality improvement to make the care that we provide for patients better—and isn’t that why we are all here anyway?


  1. Thanks Dr. Djuricich. For me, coming from Aviation...I really think there is power in sharing information as much possible about "near misses" that literally fall outside normal monitoring. As a young pilot, reading NASA's ASRS(Aviation Safety Reporting System) Reports helped me learn and integrate safer practices in my execution of flying. Obviously, we can't just drop the Aviation Safety "template" onto health care. But we need a similar paradigm shift.

  2. I think you are right. There have been many parallels to the aviation industry in medicine (particularly around patient safety). But there are also differences.
    Thank you for your thoughts!

  3. Hi there, I found your blog via Google while searching for such kinda informative post and your post looks very interesting for me. iolite vaporizer review