Pediatricians advised to reveal mistakes

Tell patients and families about medical errors and apologize for any harm done, the authors of a recent Ethics Rounds article in Pediatrics counsel pediatricians.

Using a case report of a premature infant with a malpositioned central line that led to severe neurologic injury as an illustration, the article discusses the emotional and ethical issues that doctors face when they recognize a mistake that has harmed a patient. Many professional medical and legal organizations now recommend disclosing mistakes fully and apologizing for harm, the authors note, a change from the previous norm of “silence, secrecy, and shame.”

Ideally, all providers involved in the error should be informed and an interprofessional team approach taken to the disclosure unless multiple providers would likely overwhelm the family or delay the conversation, the article says. To foster trust, the conversation should occur immediately after the event if possible, even in the absence of full understanding of what happened.

Puzzler: Child becomes febrile after visiting West Africa

“An atmosphere of openness and honesty leads to a culture of quality and safety,” the authors write, adding that the need for disclosure is now universally agreed upon, “at least in theory.” Failure to reveal mistakes occurs “simply because such disclosure is psychologically difficult for doctors to do,” they observe.

To get weekly clinical advice for today's pediatrician, subscribe to the Contemporary Pediatrics PediaMedia.