Physicians' barriers to disclosure of adverse medical events: Understanding the reluctance to error reporting and tailoring a hospital-based program to improve it

The incidence and severity of adverse medical errors entered public awareness with the Institute of Medicine's 2000 report To Err is Human: Building a Safer Health care System, which uncovered an estimated 44,000 to 98,000 annual deaths in the United States caused by preventable medical errors. Just as disconcerting was the finding that very few harm-causing medical errors are routinely reported and even fewer are being disclosed to the affected parties which hinders investigation of their cause and correction in order to prevent their repetition. Despite efforts by the government and the healthcare system, the release of new reports shows that medical errors not only continue to persist but have even increased in numbers over the past decade.;This study examines the reasons why so many adverse medical events go unreported. Various factors are said to deter disclosure: the legal and insurance industries, the ethical climate of the medical institution, the demands imposed by the culture of medicine, and societal expectations. However, physician fear of punishment, loss of malpractice insurance and medical license, as well as litigation do not appear to play the major role in under-disclosure.;Mistakes are a blow to self-esteem and it takes great moral courage for a physician to come forth and reveal his shortcomings to either patients or colleagues. Disclosure involves a very complex decision process; how this is handled by the physician is determined by how he deals with the psychological impact of the error, a process which is determined by his personality. Personality determines ego defense mechanisms and the coping strategies employed to deal with the blow to self-esteem; together they determine what actions he finally takes and the content of the disclosure. Hence, it really is the personality trait of the physician which functions as the major stumbling block towards improving error reporting and disclosure.;An understanding of these psychological processes is used to develop an effective three-tiered, institution-based reporting system that accommodates provider needs for emotional restoration, thereby encouraging voluntary error reporting.