Kennedy Institute of Ethics journal
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Bioethicists have articulated an ideal of shared decision making between physician and patient, but in doing so the role of clinical uncertainty has not been adequately confronted. In the face of uncertainty about the patient's prognosis and the best course of treatment, many physicians revert to a model of nondisclosure and nondiscussion, thus closing off opportunities for shared decision making. ⋯ We argue, in contrast, that effective disclosure will protect patient trust in the long run and that patients can manage information about uncertainty. In situations where there is substantial uncertainty, extra vigilance is required to ensure that patients are given the tools and information they need to participate in cooperative decision making about their care.
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Kennedy Inst Ethics J · Jun 2001
Institutional responses to medical mistakes: ethical and legal perspectives.
Health care institutions must decide whether to inform the patient of a medical error. The barriers to disclosure are an aversion to admitting errors, a concern about implicating other practitioners, and a fear of lawsuits and liability. ⋯ When examined, the barriers to such disclosures have little merit, and, in fact, lawsuits and liability may actually be reduced by informing the patient of medical errors. Therefore, a health care institution should implement a written policy providing for disclosure of medical errors, using a process such as that outlined in the article.
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Kennedy Inst Ethics J · Jun 2001
Biography Historical ArticleMistakes as a social construct: an historical approach.
The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years. ⋯ At the start of this timeframe, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone "underground" and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOM's suggestions for change and comments on what they mean for the culture of medicine.
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Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. ⋯ In this paper, we explore the relationship between the current malpractice system and clinicians' fear of litigation. Ultimately, we argue that both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.