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Medical Ethics |

Disclosing Harmful Medical Errors to Patients: Tackling Three Tough Cases

Thomas H. Gallagher, MD; Sigall K. Bell, MD; Kelly M. Smith, PhD; Michelle M. Mello, JD, PhD; Timothy B. McDonald, MD, JD
Author and Funding Information

Affiliations: From the Departments of Medicine, Bioethics, and Humanities (Dr. Gallagher), University of Washington, Seattle, WA; the Department of Medicine (Dr. Bell), Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, MA; Institute for Patient Safety Excellence (Dr. Smith), University of Illinois Medical Center at Chicago, Chicago, IL; Harvard School of Public Health (Dr. Mello), Boston, MA; and the Departments of Anesthesiology and Pediatrics (Dr. McDonald), University of Illinois Medical Center at Chicago, Chicago, IL.

Correspondence to: Thomas H. Gallagher, MD, Associate Professor of Medicine, University of Washington, 4311 Eleventh Ave NE, Suite 230, Seattle, WA 98105; e-mail: thomasg@u.washington.edu


Editor's note: The review addresses the 10th topic in the core curriculum of the ongoing Medical Ethics series.

Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics

This study was supported by the Robert Wood Johnson Investigator Award in Health Policy Research (Drs. Gallagher and Mello) and the Agency for Healthcare Research and Quality (No. 1RO1HS016506) [Dr. Gallagher].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):897-903. doi:10.1378/chest.09-0030
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A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles. We explore some of these unanswered questions by presenting three real cases that pose challenging disclosure dilemmas. The first case involves a pancreas transplant that failed due to the pancreas graft being discarded, an error that was not disclosed partly because the family did not ask clarifying questions. Relying on patient or family questions to determine the content of disclosure is problematic. We propose a standard of materiality that can help clinicians to decide what information to disclose. The second case involves a fatal diagnostic error that the patient's widower was unaware had happened. The error was not disclosed out of concern that disclosure would cause the widower more harm than good. This case highlights how institutions can overlook patients' and families' needs following errors and emphasizes that benevolent deception has little role in disclosure. Institutions should consider whether involving neutral third parties could make disclosures more patient centered. The third case presents an intraoperative cardiac arrest due to a large air embolism where uncertainty around the clinical event was high and complicated the disclosure. Uncertainty is common to many medical errors but should not deter open conversations with patients and families about what is and is not known about the event. Continued discussion within the medical profession about applying disclosure principles to real-world cases can help to better meet patients' and families' needs following medical errors.


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