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The ethics of revealing diagnostic errors

  • 1.  The ethics of revealing diagnostic errors

    Posted 05-05-2020 09:43

  • 2.  RE: The ethics of revealing diagnostic errors

    Posted 05-05-2020 10:25
    I will add that the lead author is one of our SIDM Fellows!  

    Congratulations, Dr. Shafer!

    Andrew P.J. Olson, MD
    Associate Professor of Medicine & Pediatrics
    Director of Medical Education Research and Innovation
    Medical Education Outcomes Center
    Director, Becoming a Doctor Course
    University of Minnesota Medical School
    (o) 612-625-2290
    (p) 612-899-2999

  • 3.  RE: The ethics of revealing diagnostic errors

    Posted 05-06-2020 12:39
    Thanks, Ed, for sharing this article. 
    We have a far greater issue with disclosure of missed diagnoses than the presumably rare case of a researcher retrospectively finding a diagnostic error. The ethical solution proposed by Dr. Shafer and Placencia in such a situation seems obvious: "… there is potentially a responsibility to discuss with the treating clinician, who assumes responsibility for contacting the patient." I think most readers would delete the word "potentially."
    The greater issue - and the greater opportunity - lies in the ethical conflict we face when we fail to disclose the learnings from missed diagnoses represented by our worst diagnostic errors: the ones that become medical malpractice lawsuits. With 40% of med mal lawsuits being the result of diagnostic error, sharing these learnings is the lowest hanging fruit in the entire patient safety movement. Drs. Shafer and Placencia write that "the ethical discourse suggests that failure by the clinician to disclose medical errors to patients represents a breach of professional ethics." They further state that the AMA's Council on Judicial Affairs "recommends full disclosure to the patient when an error causes harm." Clearly the patient deserves to know. But when a mistake is made, why cannot the rest of us in the house of medicine learn from what happened? Educating a single clinician is a drop in the bucket. 
    Our most egregious mistakes are found in our least defensible med mal lawsuits, the ones that are settled pre-trial with non-disclosure clauses. I question the ethics - both medical and legal - of such an approach. Of course I am not advocating naming names or disclosing settlement amounts, but we must find a way to share the facts, the learnings, the story of what happened, so that the same mistake does not happen to someone else.

    Charles Pilcher MD FACEP
    Chair, Board Quality & Safety Committee
    Kirkland, WA
    Editor, Medical Malpractice Insights - Learning from Lawsuits

  • 4.  RE: The ethics of revealing diagnostic errors

    Posted 05-06-2020 13:39
    I am always astonished to see the side-stepping of responsibility when there is clear evidence of misdiagnosis. That includes the failure to communicate the diagnosis, and/or a misdiagnosis directly to the patient.  Were patients immediately given all the data that has been created from their tests, imaging and physicians' appointments, the problem of misdiagnoses would be dramatically diminished. 

    Physicians should be giving a clear rationale for the diagnosis and any subsequent treatment.  Patients are not though to be 'compliant', yet they are told not to  expect their lab results unless there is a 'problem'.  Patients are denied their imaging studies, and especially so if the findings are "incidental" to the preconceived expecations of the physician.  This paternalism is unethical and creates a well-earned mistrust of the medical world.  It cannot be supported, either ethically or practically.

    Whether or not the researcher is obliged ethically or legally to discuss the "potential" to reach the physician about errors discovered is hardly the question.  The obligation is to the patient, and secondarily to the physician, as it is clearly the patient who bares the burden of the misdiagnosis.  The ethically correct approach is to inform the patient, giving the reason for the error, and ideally, a manner in which the error can be corrected.  The reporting of these errors in research have to be public, such that all parties can benefit from that information.  

    Peggy Zuckerman

  • 5.  RE: The ethics of revealing diagnostic errors

    Posted 05-06-2020 18:49



    I agree with you.  And, we should add what happens during situations where a potential diagnostic error has occurred and a third party consultant is brought in by the patient only to find the facility holding the diagnostic information or items (like glass slides) is not so willing to part with them misciting HIPAA regulations to misdirect the patient.


    Mark Gusack, M.D.


    MANX Enterprises, Ltd.

    304 521-1980



  • 6.  RE: The ethics of revealing diagnostic errors

    Posted 05-08-2020 08:01
    Thanks for sharing this article,

    It reminds me to the story of Adrienne Cullen, an Irish Patients. In her case the diagnosis of cervical cancer remained two years unseen in her medical file.
    She wrote an impressive book about her experiences: "Deny, Dismiss, Dehumanise: What happened when I went to hospital"

    In her case,  the dokter responsible for the error did an open disclosure, but the book makes clear that more is needed, such as compassion, support and answers on the question, how it could happen (Initially no RCA was performed). But foremost: Apology. She wrote about it: "It still surprise me that the leadership still did not seem to understand that an apology is therapeutic-if it's sincere, it heals the transgressors as much as the victim."      

    I think my dutch collegues fully agree, that it is an impressive testimonial of the consequences of a diagnostic error and contains important lessons in how to deal with them.

    From the cover:
    "A unique report by a terminally ill patient from the front line of a deeply dysfunctional hospital system. Every doctor, nurse, and healthcare leader must read this!"

    ONE woman's shocking battle with the 21st century hospital that killed rather than cured her ... her chilling report from the frontline of a medical system struggling to cope with its own complexity ... and her campaign against the secrecy surrounding "avoidable medical error" which costs 100,000 lives across Europe every year.

    "I am horrified by your story ... It is of the first importance", Sir Harold Evans, campaigning former editor, The Sunday Times.