Onclogists' Difficulties in Facing and Disclosing Medical Errors: Suggestions for the Clinic

Abstract

Overview: Along with improved safety measures and changes in the culture of medicine, communication is key to reducing the effect of medical errors and to easing the medical, psychologic, and existential burdens they impose on all parties. Disclosure demonstrates respect for patients' autonomy and promotes patient's involvement in informed decision making about ways to correct or alleviate the effects of the error. It also enhances oncologists' integrity and helps restore trust in the patient-doctor relationship. Because of the complexity of cancer treatments and the uncertainty regarding outcomes in oncology, oncologists may rationalize nondisclosure as a way to avoid adding to the physical and existential suffering of their patients. Although there is broad agreement among professional and regulatory bodies, as well as medical ethicists, that physicians should disclose errors to patients—and physicians largely support disclosure of error to patients—studies show discrepancy between physicians' responses to hypothetical clinical scenarios of truth telling about medical errors and actual practices of withholding or tempering the truth. Among common reasons for avoiding disclosure are risk of malpractice lawsuits, fear of being exposed as incompetent, and feeling shame before patients and colleagues. Proper disclosure, however, including a sincere apology, should be part of the management of errors and of their long-term aftermaths. In disclosing medical errors, it is essential for oncologists to pay equal attention to the medical and the emotional aspects of the information they are giving and the reaction that it elicits in patients and families. Specific communication skills regarding disclosure of medical errors can be learned.