When it comes to their colleagues' mistakes, doctors keep mum

Michael Cook
16 Nov 2013
Reproduced with Permission

Mandatory reporting over issues like death or injury due to defective manufactured goods or over suspected child abuse is common nowadays. How about doctor error? This is one of the leading causes of death in the US -- but doctors are very reluctant to blow the whistle on their colleagues.

This happens for a range of reasons, according to a recent article in the New England Journal of Medicine. Doctors are supposed to tell patients about their own mistakes, but not necessarily about those made by other doctors. Lead author Thomas Gallagher, of the University of Washington School of Medicine, and his colleagues explain why:

"… multiple barriers, including embarrassment, lack of confidence in one's disclosure skills, and mixed messages from institutions and malpractice insurers, make talking with patients about errors challenging. Several distinctive aspects of disclosing harmful errors involving colleagues intensify the difficulties.

"One challenge is determining what happened when a clinician was not directly involved in the event in question. He or she may have little firsthand knowledge about the event, and relevant information in the medical record may be lacking. Beyond this, potential errors exist on a broad spectrum ranging from clinical decisions that are 'not what I would have done' but are within the standard of care to blatant errors that might even suggest a problem of professional competence or proficiency."

Doctor may be reluctant to expose their colleagues to the possibility of litigation. They may fear resentment, anger or ostracism by colleagues. They may be burdened by "strong cultural norms around loyalty, solidarity, and 'tattling'". In a follow-up investigation, the investigative journalism website Pro Publica was told that most institutions only report errors when it appears that the harm will come to light in other ways.

Dr Gallagher's article concludes that "transparent disclosure of errors is a shared professional responsibility".