• Lesly A Dossett, Rondi M Kauffmann, Jay S Lee, Harkamal Singh, M Catherine Lee, Arden M Morris, Reshma Jagsi, Gwendolyn P Quinn, and Justin B Dimick.
• Center for Health Outcomes and Policy, University of Michigan Institute for Health Policy and Innovation (IHPI), Ann Arbor, MI.
• Ann. Surg. 2018 Jun 1; 267 (6): 1077-1083.

ObjectiveOur objective was to determine specialist physicians' attitudes and practices regarding disclosure of pre-referral errors.Summary Background DataPhysicians are encouraged to disclose their own errors to patients. However, no clear professional norms exist regarding disclosure when physicians discover errors in diagnosis or treatment that occurred at other institutions before referral.MethodsWe conducted semistructured interviews of cancer specialists from 2 National Cancer Institute-designated Cancer Centers. We purposively sampled specialists by discipline, sex, and experience-level who self-described a >50% reliance on external referrals (n = 30). Thematic analysis of verbatim interview transcripts was performed to determine physician attitudes regarding disclosure of pre-referral medical errors; whether and how physicians disclose these errors; and barriers to providing full disclosure.ResultsParticipants described their experiences identifying different types of pre-referral errors including errors of diagnosis, staging and treatment resulting in adverse events ranging from decreased quality of life to premature death. The majority of specialists expressed the belief that disclosure provided no benefit to patients, and might unnecessarily add to their anxiety about their diagnoses or prognoses. Specialists had varying practices of disclosure including none, non-verbal, partial, event-dependent, and full disclosure. They identified a number of barriers to disclosure, including medicolegal implications and damage to referral relationships, the profession's reputation, and to patient-physician relationships.ConclusionsSpecialist physicians identify pre-referral errors but struggle with whether and how to provide disclosure, even when clinical circumstances force disclosure. Education- or communication-based interventions that overcome barriers to disclosing pre-referral errors warrant development.

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