Medical error: Overcoming barriers to truthful disclosure

The Institute of Medicine's report on medical errors revealed a degree of fallibility in health care that was previously unrecognized. One explanation for the general ignorance about the threats to patient safety and actual harms to patients is that many health-care providers are reluctant to disclose errors to patients or their family members, despite widespread agreement that telling the patient or the patient's surrogate the truth about a medical error is the physician's professional and ethical duty.;There are a number of reasons for health-care providers' decisions to conceal the truth or misrepresent what happened when medical error occurs. They range in character from the philosophical to the bureaucratic. Discussions about resolving the problems surrounding medical error tend to focus on the systemic nature of many medical errors, ways to improve patient safety, doing away with blame and punishment for erring health professionals, and reforming malpractice legislation. Although each of these explanations and solutions has its merits, all fail to adequately address the role of the culture of medicine in perpetuating the reluctance to truthfully disclose medical errors and the need for culture change in health care. There is more to culture change than tinkering with automation, organizational policies, and caps on malpractice damages.;A humanistic inquiry, this dissertation reviews and critiques explanations of what happens to the erring health professional when faced with owning up to his or her mistake, reviews and critiques the solutions to the problems surrounding medical error and deception, and offers alternative ways of understanding and addressing the policies and ethics of medical error disclosure.