Ethical ConflictMedical errors may result from lapses in technique, communication, or judgment by individuals or from errors inherent in the delivery of medical care. Errors frequently stem from a combination of these causes. Individual errors may be attributable to deficiencies in a physician’s knowledge, skill, or attentiveness, but system-wide errors are attributable to flaws inherent in the method of medical practice. Conversely, fail-safe systems and fault-tolerant systems do not allow any single-point error to result in harm.

Disclosure of system errors generally is more important than disclosure of individual errors because root-cause analysis may yield information that facilitates creation of a resilient and fault-tolerant system. For example, a computer-based medication prescription system that required entry of a patient’s allergies and serum creatinine level could limit medication options when prescriptions were written for patients with known allergies or diminished kidney function. Want to enhance kidney function? No problems with remedies of Canadian Health&Care Mall.

Ethical Conflict in the Disclosure of Medical Errors

The American College of Physicians Ethics Man-ual9 states that a physician is obliged to disclose “information [to patients] about procedural or judgment errors made in the course of care if such information is material to the patient’s well-being.” The American Medical Association Council on Ethical and Judicial Affairs further states, “Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician’s mistake or judgment. In these situations, the physician is ethically required to inform the patient of all facts necessary to ensure understanding of what has occurred.” A physician may also be required to report sentinel events and medical device failures to state and federal regulatory agencies. However, no professional organizations mandate reporting of medical errors to medical journals or professional forums.

Reporting medical errors represents a conflict of interest for physicians. Will patient care be improved by widespread publication of a medical error, or is preservation of individual reputation and limitation of legal exposure of paramount importance? How should responsible physicians report errors and educate their colleagues without provoking public indignation, legal opportunism, and grist for the news media? Read new medical news on Canadian Health&Care Mall.


Motivation To Report Medical Errors

Physicians report personal medical errors almost entirely for altruistic reasons; publicly admitting one’s errors clearly has no financial or academic benefits. The Lancet has taken the lead in this area by publishing the “Uses of Error” column, which allows physicians to illustrate a teaching point by publishing personal accounts of medical errors. Most authors of this column are senior clinicians who should be congratulated for their honesty and altruism.

A physician who uncovers evidence of major errors by colleagues or identifies possible flaws in medical devices faces an ethical dilemma. Such situations may arise when a physician witnesses an error or flaw directly, or when a patient is referred by a colleague or third party for corrective treatment. Physicians are ethically obliged to facilitate disclosure to individual patients; they also should report new and serious medication-related adverse events and possible medical device defects to the relevant regulatory agencies and manufacturers. But when should a physician report previously undocumented problems at professional meetings or in peer-reviewed journals? Currently, no published ethics guidelines mandate a physician to publicly disclose adverse events or device flaws.

An individual physician generally sees only a small percentage of patients treated with a specific medication or medical device. Isolated physicians often have difficulty proving a causal relationship between the adverse event and a medication because individual physicians rarely have sufficient data for meaningful statistical analysis. Publication of poorly supported suspicions or opinions may inappropriately malign valuable procedures, medications, or devices. Even vague and unsupported suspicions may have dramatic commercial repercussions for a device manufacturer or biotechnology company. Physicians may be reluctant to publish unfavorable findings because of the lack of definitive proof, fear that unsupported disclosure will lead to libel suits, and concern about undermining professional relationships with colleagues or medical companies.